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Bafna KR, Kalra-Lall A, Gurajala RK, Karuppasamy K. Computed Tomography-Guided Pericardiocentesis: A Practical Guide. Curr Cardiol Rep 2023; 25:1433-1441. [PMID: 37856032 DOI: 10.1007/s11886-023-01965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE OF REVIEW The purpose of this article is to serve as a practical guide to computed tomography (CT)-guided pericardiocentesis and to discuss the role of this approach in current clinical practice. An overview of indications, technique, advantages, and limitations specific to CT-guided pericardiocentesis will be provided. The reader will have an enhanced understanding of the use of this imaging modality to guide pericardial drainage. RECENT FINDINGS Use of CT guidance to drain the pericardial space is safe, especially when adequate echocardiographic evaluation is precluded and when echocardiography-guided pericardiocentesis is deemed unsafe and or not feasible. Our review and experience indicate that CT-guided pericardiocentesis is technically successful in more than 94% of patients, with a low risk (<1%) of significant complications. CT-guided pericardiocentesis is therefore a viable alternative when echocardiographic guidance is insufficient and can obviate the need for surgery in most patients.
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Affiliation(s)
- Kunaal R Bafna
- Section of Interventional Radiology, Cleveland Clinic 9500 Euclid Avenue, L10, Cleveland, OH, 44195, USA
| | - Anouva Kalra-Lall
- Section of Interventional Radiology, Cleveland Clinic 9500 Euclid Avenue, L10, Cleveland, OH, 44195, USA
| | - Ram Kishore Gurajala
- Section of Interventional Radiology, Cleveland Clinic 9500 Euclid Avenue, L10, Cleveland, OH, 44195, USA
| | - Karunakaravel Karuppasamy
- Section of Interventional Radiology, Cleveland Clinic 9500 Euclid Avenue, L10, Cleveland, OH, 44195, USA.
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Feng C, Lei Z, Xiyang P. Transthoracic Color Doppler Ultrasound-Guided Grooved Negative Pressure Drainage Tube Implantation in Pericardial Effusion After Cardiac Surgery. Braz J Cardiovasc Surg 2023; 38:e20220044. [PMID: 36592070 PMCID: PMC10552204 DOI: 10.21470/1678-9741-2022-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/15/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Pericardial effusion is a common complication without a standard postoperative effusion treatment after cardiac surgery. The grooved negative pressure drainage tube has many advantages as the emerging alternative for drainage of pericardial effusion, such as it changes the structure of the traditional side hole, uses the capillary function to ensure drainage smooth, etc. The purpose of this study was to assess the feasibility and effectiveness of transthoracic color Doppler ultrasound-guided grooved negative pressure drainage tube implantation in pericardial effusion after cardiac surgery. METHODS All patients with pericardial effusion after cardiac surgery who underwent transthoracic color Doppler ultrasound-guided grooved negative pressure drainage tube implantation between January 2019 and December 2021 were retrospectively analyzed. Treatment results (including clinical symptoms, effusion volume, color Doppler ultrasonography, and computed tomography scan) were investigated to evaluate the effectiveness and safety of this method. RESULTS A total of 20 patients successfully underwent transthoracic color Doppler ultrasound-guided grooved negative pressure drainage tube implantation. After the operation, their symptoms (chest tightness, shortness of breath, etc.) were all relieved, and dark red or light red drainage fluid (> 200 ml) appeared in the newly placed drainage bottle. Color Doppler ultrasonography showed that the volume of pericardial effusion decreased significantly. CONCLUSION The transthoracic color Doppler ultrasound-guided grooved negative pressure drainage tube is a safe and effective method for the treatment of postoperative pericardial effusion with less trauma, faster recovery, shorter in-hospital stay, and fewer complications.
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Affiliation(s)
- Can Feng
- Department of Cardiothoracic Surgery, The First Affiliated Hospital
of University of South China, Hengyang, Hunan, People’s Republic of China
| | - Zhengwen Lei
- Department of Cardiothoracic Surgery, The First Affiliated Hospital
of University of South China, Hengyang, Hunan, People’s Republic of China
| | - Peng Xiyang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital
of University of South China, Hengyang, Hunan, People’s Republic of China
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Hoit BD. Pericardial Effusion and Cardiac Tamponade Pathophysiology and New Approaches to Treatment. Curr Cardiol Rep 2023; 25:1003-1014. [PMID: 37515704 DOI: 10.1007/s11886-023-01920-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE OF REVIEW The objective of this manuscript is to examine up-to-date approaches to the diagnosis and treatment of pericardial effusions and cardiac tamponade. RECENT FINDINGS Recent recommendations from the American Society of Echocardiography and the European Society of Cardiology have improved our management of the patient with pericardial effusion and cardiac tamponade, but significant knowledge gaps remain. Novel diagnostic and triage strategies have been suggested, and recent information have improved our facility to assess the presence and size of a pericardial effusion, assess its hemodynamic impact, and determine its cause. Despite these recent findings, there is a scarcity of evidence-based data to direct the management of pericardial effusion and cardiac tamponade. While the first-line function of echocardiography in managing these disorders is undisputed, there are increasingly niche functions for multimodality imaging.
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Affiliation(s)
- Brian D Hoit
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
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Ya'Qoub L, Butera B, Sorek C, Lemor A, Alqarqaz M, Villablanca P. Computed Tomography-Guided Pericardiocentesis for a Loculated Pericardial Effusion With Tamponade. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53S:S326-S328. [PMID: 36089456 DOI: 10.1016/j.carrev.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Lina Ya'Qoub
- Division of Interventional Cardiology, Henry Ford Hospital, Detroit, MI, United States of America.
| | - Brian Butera
- Division of Interventional Cardiology, Henry Ford Hospital, Detroit, MI, United States of America
| | - Claire Sorek
- Department of Radiology, Henry Ford Hospital, Detroit, MI, United States of America
| | - Alejandro Lemor
- Division of Interventional Cardiology, Henry Ford Hospital, Detroit, MI, United States of America
| | - Mohammad Alqarqaz
- Division of Interventional Cardiology, Henry Ford Hospital, Detroit, MI, United States of America
| | - Pedro Villablanca
- Division of Structural Heart Disease, Henry Ford Hospital, Detroit, MI, United States of America
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Ibrahim AO, Jaber F, Alghizzawi M, Metzinger M, Asif T. CT-Guided Pericardiocentesis in a Case of Tension Pneumopericardium and Tamponade Secondary to an Enteropericardial Fistula. JACC Case Rep 2023; 18:101909. [PMID: 37545683 PMCID: PMC10401056 DOI: 10.1016/j.jaccas.2023.101909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/04/2023] [Accepted: 05/11/2023] [Indexed: 08/08/2023]
Abstract
Tension pneumopericardium is most commonly traumatic. Nontraumatic etiologies are rare, but have been reported with gastropericardial and esophagopericardial fistulas. We present the case of a 54-year-old patient who developed a tension pneumopericardium with tamponade secondary to a perforated marginal ulcer in the proximal jejunum with an enteropericardial fistula. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Ali O. Ibrahim
- Address for correspondence: Dr Ali O. Ibrahim, Department of Medicine, UMKC School of Medicine, 2411 Holmes Street, Kansas City, Missouri 64108, USA. @Ali_O_Ibrahim
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Ingber RB, Al-Roubaie M, Lodhi U, Greben C. CT-Guided Pericardial Drainage: A Safe and Viable Alternative to Ultrasound-Guided Drainage. Semin Intervent Radiol 2022; 39:329-333. [PMID: 36062228 PMCID: PMC9433151 DOI: 10.1055/s-0042-1751284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Ross B. Ingber
- Division of Vascular and Interventional Radiology, Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Mustafa Al-Roubaie
- Division of Vascular and Interventional Radiology, Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Umairullah Lodhi
- Division of Vascular and Interventional Radiology, Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Craig Greben
- Division of Vascular and Interventional Radiology, Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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Therapeutic Computed Tomography-Guided Pericardiocentesis: Lessons Learned Based on a 7-Year Single-Center Experience. J Comput Assist Tomogr 2021; 45:643-648. [PMID: 34270484 DOI: 10.1097/rct.0000000000001190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Pericardiocentesis is a well-known procedure commonly performed by either image-guided intervention or surgical approaches. Computed tomography (CT)-guided pericardiocentesis is not widely used, but provides certain advantages. In the article we will discuss our technique of CT-guided therapeutic pericardiocentesis, including advantages and disadvantages, patient selection, possible approaches, and complications. METHODS The retrospective study included 121 therapeutic pericardial drainages performed under CT guidance. Demographic data of the patients, entry site, and needle orientation were recorded. Procedure complications and their significance were analyzed. RESULTS One hundred and twenty-one pericardial drainages with catheter insertion were performed under CT guidance on 119 patients presenting with clinically significant pericardial effusion. The most common approach was at the left anterior chest wall. The rate of minor complications was 5.8%, no major complications occurred. CONCLUSIONS Therapeutic pericardiocentesis can be obtained under CT guidance in a safe and effective manner. Recommendations for building a patient-centered protocol with an interdisciplinary team are discussed. Patient selection, procedural guidance, and lessons to avoid complications are reviewed.
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Zhang L, Zhang XF, Liu Z, Liu Y, Guo CL, Shao H, Li B, Zhang C, Jing H, Cheng W. High frequency ultrasound-guided pericardiocentesis performed in the sitting position: A novel apical approach. Clin Cardiol 2021; 44:1106-1112. [PMID: 34101857 PMCID: PMC8364732 DOI: 10.1002/clc.23657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/08/2021] [Accepted: 05/12/2021] [Indexed: 12/26/2022] Open
Abstract
Background So far, few approaches have been described to reduce inadvertent injury to structure of the heart and nearby organs in percutaneous pericardiocentesis. Hypothesis We hypothesized that an in‐plane high frequency ultrasound‐guided apical approach, performed in the sitting position, would provide additional benefits in terms of feasibility and safety for draining malignant pericardial effusion (MPE). Methods The authors selected 53 consecutive patients with moderate or large symptomatic MPE who underwent high frequency ultrasound‐guided pericardiocentesis. After the procedure, all patients were followed for 90 days with the main purpose of detecting procedure success, procedure‐related complications, and recurrent PE. Results Procedure success rate for pericardiocentesis was 100%. All patients were placed in the sitting position with their left hands extended above the heads. An apical puncture approach was performed in all cases (100%). The mean duration of catheter drainage was 8.1 ± 3.2 days. The mean initial amount of pericardial fluid drained was 956.3 ± 687.5 ml. Overall, six patients (11%) had recurrent PE; 3 (6%) had repeated percutaneous pericardiocentesis. There was no major complication and minor complications occurred in four patients (8%). Conclusion This novel in‐plane high frequency US‐guided apical approach has several advantages for percutaneous pericardiocentesis of MPE: performed in the sitting position; a benefit for patients with orthopnea; a maximum inserted wide angle to prevent damage to the myocardium; local enlargement of the PE region; high procedure success rate of pericardiocentesis; and excellent clinical outcomes.
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Affiliation(s)
- Lei Zhang
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China.,Interventional Ultrasound Ward, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xue-Fei Zhang
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China.,Interventional Ultrasound Ward, Harbin Medical University Cancer Hospital, Harbin, China
| | - Zhao Liu
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Ying Liu
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Cun-Li Guo
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hua Shao
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Bo Li
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Cui Zhang
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hui Jing
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China.,Interventional Ultrasound Ward, Harbin Medical University Cancer Hospital, Harbin, China
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Luis SA, Kane GC, Luis CR, Oh JK, Sinak LJ. Overview of Optimal Techniques for Pericardiocentesis in Contemporary Practice. Curr Cardiol Rep 2020; 22:60. [PMID: 32562136 DOI: 10.1007/s11886-020-01324-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW This review summarizes the optimal techniques for the performance of pericardiocentesis in contemporary practice, highlighting the indications, contraindications, and techniques used. Routine pericardial catheter management and the diagnostic role of pericardial fluid analysis are described. RECENT FINDINGS Echocardiographic-guided pericardiocentesis should be considered the therapy of choice in current clinical practice and may be performed safely despite the presence of coagulopathy and thrombocytopenia in the hands of expert operators. Computed tomography (CT)-guided techniques may provide a useful adjunctive tool in patients with poor acoustic windows or complex loculated effusions. Conservative management utilizing pericardiocentesis may be considered in select patients with device lead and interventional-related pericardial effusions. Echocardiographic-guided pericardiocentesis with extended pericardial drainage (goal output < 50 mL/24 h) should be considered the standard of care in contemporary practice. Pericardial fluid analysis should be tailored based on the clinical history and appearances of the pericardial fluid.
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Affiliation(s)
- Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Chris R Luis
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Lawrence J Sinak
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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State-of-the-art Review: Interventional Onco-Cardiology. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00809-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Donisan T, Balanescu DV, Palaskas N, Lopez-Mattei J, Karimzad K, Kim P, Charitakis K, Cilingiroglu M, Marmagkiolis K, Iliescu C. Cardiac Interventional Procedures in Cardio-Oncology Patients. Cardiol Clin 2020; 37:469-486. [PMID: 31587788 DOI: 10.1016/j.ccl.2019.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Comorbidities specific to the cardio-oncology population contribute to the challenges in the interventional management of patients with cancer and cardiovascular disease (CVD). Patients with cancer have generally been excluded from cardiovascular randomized clinical trials. Endovascular procedures may represent a valid option in patients with cancer with a range of CVDs because of their minimally invasive nature. Patients with cancer are less likely to be treated according to societal guidelines because of perceived high risk. This article presents the specific challenges that interventional cardiologists face when caring for patients with cancer and the modern tools to optimize care.
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Affiliation(s)
- Teodora Donisan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA. https://twitter.com/TDonisan
| | - Dinu Valentin Balanescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA. https://twitter.com/dinubalanescu
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA
| | - Kaveh Karimzad
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA
| | - Peter Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA
| | - Konstantinos Charitakis
- Department of Cardiology, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USA
| | - Mehmet Cilingiroglu
- Department of Cardiology, Arkansas Heart Hospital, 1701 South Shackleford Road, Little Rock, AR 72211, USA
| | | | - Cezar Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA.
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