title: Percutaneous balloon pericardiotomy: Treatment of choice in patients with advanced oncological disease and severe pericardial effusion.
abstract: OBJECTIVE
  Malignant pericardial effusion has a high recurrence rate after pericardiocentesis. We sought to confirm the efficacy and feasibility of percutaneous balloon pericardiotomy (PBP) as the initial treatment of choice for these effusions.
  
  
  METHODS
  Retrospective analysis of the clinical, echocardiographic, and follow-up characteristics of a consecutive series of PBP carried out in a single-center in patients with advanced cancer.
  
  
  RESULTS
  Forty PBPs were performed in 35 patients with a mean age of 61.8years (55% females). Thirty-four patients had pathologically confirmed metastatic neoplastic disease (26 patients with tumoral cells in the pericardial liquid), 7 had previously required pericardiocentesis, and in the remaining patients PBP was the first treatment for the effusion. All patients had a severe circumferential effusion (29mm by mean on transthoracic echocardiography [TTE]), and most presented evidence of hemodynamic compromise on TTE. In all cases, the procedure was successful, there were no acute complications, and it was well tolerated at the first attempt. There were no infectious complications during follow-up. One patient developed a pseudoaneurysm in the right ventricle, even though no further treatment was required. Eight patients needed a new pericardial procedure: 3 had elective pericardial window surgeries and 5 had a second PBP. Eighty percent of patients died during follow-up (57days by mean from the PBP) regarding their oncological disease.
  
  
  CONCLUSIONS
  PBP is a simple and safe technique that can be effective in the prevention of recurrence in many patients with severe malignant pericardial effusion. The characteristics of this procedure make it particularly useful in this group of patients to avoid more aggressive, poorly tolerated approaches, since they have a very poor prognosis regarding to their oncological disease.
authors.affiliation: Cardiology Department, La Paz University Hospital, Madrid, Spain. Electronic address: firazusta88@gmail.com.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Irazusta
authors.affiliation: Cardiology Department, La Paz University Hospital, Madrid, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Jiménez-Valero
authors.affiliation: Cardiology Department, La Paz University Hospital, Madrid, Spain.
authors.forename: Daniele
authors.initials: D
authors.lastname: Gemma
authors.affiliation: Cardiology Department, La Paz University Hospital, Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Meras
authors.affiliation: Cardiology Department, La Paz University Hospital, Madrid, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Galeote
authors.affiliation: Cardiology Department, La Paz University Hospital, Madrid, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Sanchez-Recalde
authors.affiliation: Cardiology Department, La Paz University Hospital, Madrid, Spain.
authors.forename: Veronica
authors.initials: V
authors.lastname: Rial
authors.affiliation: Cardiology Department, La Paz University Hospital, Madrid, Spain.
authors.forename: Raul
authors.initials: R
authors.lastname: Moreno
authors.affiliation: Cardiology Department, La Paz University Hospital, Madrid, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Lopez-Sendon
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography / Q000379:methods; D005260:Female; D006338:Heart Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D010490:Pericardial Effusion / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D010492:Pericardiectomy / Q000379:methods; D020519:Pericardiocentesis / Q000379:methods; D011379:Prognosis
keywords: Malignant pericardial effusion; Oncological disease; Percutaneous balloon pericardiotomy