Rescue echocardiographically guided pericardiocentesis for cardiac perforation complicating catheter-based procedures: The Mayo Clinic experience

• Published in: Journal of the American College of Cardiology Vol. 32; no. 5; pp. 1345 - 1350
• Main Authors: TSANG, T. S. M, FREEMAN, W. K, BARNES, M. E, REEDER, G. S, PACKER, D. L, SEWARD, J. B
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Science 01.11.1998
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiac Catheterization - adverse effects; Cardiac Tamponade - epidemiology; Cardiac Tamponade - etiology; Cardiac Tamponade - surgery; Child; Child, Preschool; Diseases of the cardiovascular system; Echocardiography; Emergency Treatment - methods; Female; Follow-Up Studies; Heart Injuries - epidemiology; Heart Injuries - etiology; Heart Injuries - surgery; Humans; Incidence; Infant; Infant, Newborn; Male; Medical sciences; Middle Aged; Paracentesis - methods; Pericardial Effusion - complications; Pericardial Effusion - epidemiology; Pericardial Effusion - surgery; Pericardium - diagnostic imaging; Pericardium - surgery; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Safety; Survival Rate; Treatment Outcome; Sonography; Heart; Human; Echocardiography; Catheterization; Perforation; Treatment efficiency; Cardiac tamponade; Instrumentation therapy; Cardiovascular disease; Trauma; Pericardium; Guidance; Treatment; Heart disease; Pericardial disease; Complication; Puncture; Technique
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(98)00390-8

The purpose of this study was to determine the safety and efficacy of rescue echocardiographically guided pericardiocentesis as a primary strategy for the management of acute cardiac perforation and tamponade complicating catheter-based procedures. In this era of interventional catheterization, acute tamponade from cardiac perforation as a complication is encountered more frequently. The safety and efficacy of echocardiographically guided pericardiocentesis in this life-threatening situation and outcomes of patients managed by this technique are unknown. Of the 960 consecutive echocardiographically guided pericardiocenteses performed at the Mayo Clinic (1979 to 1997), 92 (9.6%) were undertaken in 88 patients with acute tamponade that developed in association with a diagnostic or interventional catheter-based procedure. Most of the patients were hemodynamically unstable at the time of pericardiocentesis, with clinically overt tamponade in 40% and frank hemodynamic collapse (systolic blood pressure <60 mm Hg) in 57%. Clinical end points of interest were the success and complication rates of rescue pericardiocentesis and patient outcomes, including the need for other interventions, clinical and echocardiographic follow-up findings and survival. Rescue pericardiocentesis was successful in relieving tamponade in 91 cases (99%) and was the only and definitive therapy in 82% of the cases. Major complications (3%) included pneumothorax (n=1), right ventricular laceration (n=1) and intercostal vessel injury with right ventricular laceration (n=1); all were treated successfully. Minor complications (2%) included a small pneumothorax and an instance of transient nonsustained ventricular tachycardia; all were resolved spontaneously. Further surgical intervention was performed in 16 patients (18%). No deaths resulted from the rescue pericardiocentesis procedure itself. Early death (<30 days) in this series was due to injuries from cardiac catheter-based procedures (n=3), perioperative complications (n=2) and underlying cardiac diseases (n=2). Clinical or echocardiographic follow-up for a minimum of 3 months or until death (if <3 months) for recurrent effusion or development of pericardial constriction was achieved in 87 (99%) of the patients. Echocardiographically guided pericardiocentesis was safe and effective for rescuing patients from tamponade and reversing hemodynamic instability complicating invasive cardiac catheter-based procedures. For most patients, this was the definitive and only therapy necessary.