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Butcher A, Castillo C. Point-of-Care Echocardiographic Evaluation of the Pericardium. Semin Ultrasound CT MR 2024; 45:84-90. [PMID: 38056788 DOI: 10.1053/j.sult.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Acute pericardial conditions, such as tamponade, are often rapidly progressive and can become life-threatening without timely diagnosis and intervention. In this review, we aim to describe bedside ultrasonographic evaluation of the pericardium and diagnostic criteria for tamponade, identify confounders in the diagnosis of pericardial tamponade, and delineate procedural details of ultrasound-guided pericardiocentesis.
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Affiliation(s)
- Amy Butcher
- Department of Cardiothoracic and Thoracic Surgery, South Shore University Hospital, Northwell Health, 305 E Main St., Bay Shore, NY 11706.
| | - Cesar Castillo
- Department of Anesthesia and Critical Care, Baylor College of Medicine, Baylor St. Luke's Medical Center, 6720 Bertner Ave, Houston, TX 77030
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Cruz JC, Edelstein M. Ultrasonography-Guided Procedures in the Intensive Care Setting. AACN Adv Crit Care 2023; 34:201-206. [PMID: 37644633 DOI: 10.4037/aacnacc2023551] [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] [Indexed: 08/31/2023]
Abstract
Ultrasonography guidance can help make procedures safer and more effective, particularly in the intensive care setting. This article discusses techniques to optimize periprocedural ultrasonography and reviews common intensive care procedures for which ultrasonography can be used: vascular access procedures, paracentesis, thoracentesis, and pericardiocentesis.
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Affiliation(s)
- Jeffrey C Cruz
- Jeffrey C. Cruz is Assistant Professor of Clinical Radiology, Division of Interventional Radiology, Department of Radiology, Temple University Hospital, Temple University Health System, 3401 N Broad Street, Philadelphia, PA 19140
| | - Mark Edelstein
- Mark Edelstein is Intergrated Interventional Radiology Resident, Division of Interventional Radiology, Department of Radiology, Temple University Hospital, Temple University Health System
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Krishnan S, Park JH, Siddiqui N, Halabi AR, Ahluwalia G, Desai RG, Patel KM. "The Pericardial Effusion is Drained, But the Catheter Is Stuck"-Percutaneous Evacuation of Pericardial Effusion Complicated by Pigtail Catheter Entrapment in Fibrinous Pericarditis. J Cardiothorac Vasc Anesth 2022; 36:3216-3220. [PMID: 35469716 DOI: 10.1053/j.jvca.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Sandeep Krishnan
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI; Department of Anesthesiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI.
| | - Jee Ha Park
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI
| | - Nazia Siddiqui
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI
| | - Abdul R Halabi
- Department of Cardiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Guneet Ahluwalia
- Department of Cardiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Ronak G Desai
- Department of Anesthesiology, Cooper University Healthcare, Camden, NJ
| | - Kinjal M Patel
- Department of Anesthesiology, Cooper University Healthcare, Camden, NJ
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Alerhand S, Adrian RJ, Long B, Avila J. Pericardial tamponade: A comprehensive emergency medicine and echocardiography review. Am J Emerg Med 2022; 58:159-174. [DOI: 10.1016/j.ajem.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/03/2022] [Indexed: 10/18/2022] Open
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Zhang Q, Wang D, Liu Y. Mediastinal effusion due to pericardiocentesis with cardiac tamponade: a case report. BMC Anesthesiol 2021; 21:172. [PMID: 34134618 PMCID: PMC8207801 DOI: 10.1186/s12871-021-01385-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/27/2021] [Indexed: 12/15/2022] Open
Abstract
Background Pericardiocentesis is an effective treatment for cardiac tamponade, but there are risks, including haemorrhagic events, cardiac perforation, pneumothorax, arrhythmia, acute pulmonary oedema and so on. Mediastinal effusion caused by puncture is rarely reported. Case presentation A 47-year-old man who had a history of right leg deep vein thrombosis and pulmonary artery embolism with implantation of an inferior vena cava filter presented for inferior vena cava filter removal. Within 30 min after the procedure, he developed chest pain, nausea, vomiting and presyncope with shock. Echocardiography confirmed massive pericardial effusion with evidence of cardiac tamponade. Emergency pericardiocentesis was performed. Confusingly, only 3 mL of bloody pericardial effusion was drained in total, and subsequently, the patient’s symptoms rapidly improved with stable haemodynamics. Repeat echocardiography showed that the pericardial effusion had disappeared. Urgent computed tomography pulmonary angiography demonstrated localized effusion, which was not seen the previous computed tomography results and was noted around the left ventricle in the mediastinal apace. No intervention was performed, given that there was no bleeding tendency or further adverse events related to the mediastinal effusion. The patient was subsequently discharged in a stable condition a few days later, and outpatient follow-up was advised. Conclusions Mediastinal effusion is a rare complication of pericardiocentesis. In the case described herein, the most likely cause was pericardial effusion extravasated into the mediastinum through the needle insertion site in the puncture process due to large pressure variations in the intrapericardial space with tamponade, differing from cases of over-anticoagulation reported in the previous literature. Just as our case demonstrates that conservative treatment of an hemodynamic insignificant mediastinal effusion may be appropriate. Echocardiography is useful and effective to minimize complication rates. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01385-8.
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Affiliation(s)
- Qian Zhang
- Department of Intensive Care Unit (ICU), The Affiliated Hospital of Guizhou Medical University, 550004, Guiyang, Guizhou, P.R. China
| | - Difen Wang
- Department of Intensive Care Unit (ICU), The Affiliated Hospital of Guizhou Medical University, 550004, Guiyang, Guizhou, P.R. China
| | - Ying Liu
- Department of Intensive Care Unit (ICU), The Affiliated Hospital of Guizhou Medical University, 550004, Guiyang, Guizhou, P.R. China.
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Baqi A, Ahmed I. Pericardiocentesis Indications and Complications: A Retrospective Observational Study in a Tertiary Care Hospital in Karachi, Pakistan. Cureus 2020; 12:e10102. [PMID: 33005522 PMCID: PMC7522186 DOI: 10.7759/cureus.10102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Pericardiocentesis is crucial for the diagnosis and management of diseases responsible for significant pericardial effusions. Pericardiocentesis was performed the first time by Riolanus for cardiac tamponade. He described the process of trephination of the sternum to remove the abnormally accumulated fluid from the pericardial space. However, with the advancement of expertise in echocardiography assisted procedures, echocardiography-guided diagnostic and therapeutic pericardiocentesis is now considered standard clinical practice in the treatment of pericardial effusions. OBJECTIVES We aim to study different causes of pericardial effusion and indications of pericardiocentesis as well as complications associated with it in our population. METHODS This is a retrospective observational study done at Aga Khan University Hospital, Karachi. We reviewed hospital record files of 66 patients admitted to Aga Khan University Hospital from January 2010 to December 2019 who underwent pericardiocentesis. RESULTS Out of 66 patients, 43 (65.2%) were male. The mean age of the study population was 48.59±18.9 years and 41 (62.1%) of them had underlying active malignancy with hematological malignancies being most common followed by lung carcinoma. In the majority of patients (71.2%), pericardiocentesis was performed at the bedside, and the rest of them (28.8%) underwent pericardiocentesis in the cardiac catheterization laboratory. Of all the patients, 46 (69.7%) underwent pericardiocentesis under echocardiography guidance and 18 (27.3%) required fluoroscopy. Successful pericardiocentesis was performed in 65 (98.5%) of the patients, two (3%) patients developed access site infection and only one (1.5%) patient became hemodynamically unstable while undergoing pericardiocentesis Conclusion: Malignancy, predominantly lymphoma, is the most common cause of pericardial effusion requiring pericardiocentesis. Dyspnea is the most common symptom of presentation with cardiac tamponade. Echocardiography is the commonly used imaging modality for pericardiocentesis. Bedside setting is the most common setting used for pericardiocentesis. Imaging guided pericardiocentesis has a very high success and low complication rate.
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Affiliation(s)
- Abdul Baqi
- Cardiology, Aga Khan University Hospital, Karachi, PAK
| | - Intisar Ahmed
- Cardiology, Aga Khan University Hospital, Karachi, PAK
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Cheong XP, Law LKP, Seow SC, Tay LWE, Tan HC, Yeo WT, Low AF, Kojodjojo P. Causes and prognosis of symptomatic pericardial effusions treated by pericardiocentesis in an Asian academic medical centre. Singapore Med J 2020; 61:137-141. [PMID: 32488274 PMCID: PMC7905117 DOI: 10.11622/smedj.2019065] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study aimed to investigate the causes, clinical management and outcomes of clinically significant pericardial effusions, and evaluate the practice of pericardiocentesis within an academic medical centre in Singapore, a multiethnic country in Southeast Asia. METHODS Consecutive patients undergoing pericardiocentesis at a single Asian academic medical centre were identified. Patient demographics, echocardiographic findings, investigations, pericardiocentesis procedural details and clinical progress were tracked using a comprehensive electronic medical records system. RESULTS Of 149 patients who underwent pericardiocentesis, malignancy (46.3%) was the most common cause of pericardial effusions, followed by iatrogenic postsurgical complications (17.4%). 77.3% of effusions were large and 69.8% demonstrated tamponade physiology. Pericardiocentesis guided by echocardiography and fluoroscopy was successful in 99.3% of patients and had a complication rate of 2.0%. Likelihood of effusion recurrence and survival to discharge was determined by the aetiology of the pericardial effusion. 24.6% of malignant effusions recurred, and the survival rate 12 months after drainage of a malignant pericardial effusion was 45.0%. Short-term mortality was highest among patients presenting with tamponade due to acute aortic syndromes and those with myocardial rupture due to ischaemic heart disease. CONCLUSION Cancer and iatrogenic complications were the most common causes of pericardial effusion in this large cohort of Singapore patients. Pericardiocentesis has a high success rate and relatively low complication rate. Prognosis and clinical course after pericardiocentesis are determined by the underlying cause of the pericardial effusion.
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Affiliation(s)
- Xian Pei Cheong
- Department of Cardiology, National University Heart Centre, Singapore
| | | | - Swee-Chong Seow
- Department of Cardiology, National University Heart Centre, Singapore
| | - Lik Wui Edgar Tay
- Department of Cardiology, National University Heart Centre, Singapore
| | - Huay Cheem Tan
- Department of Cardiology, National University Heart Centre, Singapore
| | - Wee Tiong Yeo
- Department of Cardiology, National University Heart Centre, Singapore
| | - Adrian F Low
- Department of Cardiology, National University Heart Centre, Singapore
| | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre, Singapore
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Abstract
Supplemental Digital Content is available in the text. Objective The aim of this study was to evaluate a novel pericardiocentesis technique using an in-plane parasternal medial-to-lateral approach with the use of a high-frequency probe in patients with cardiac tamponade. Background Echocardiography is pivotal in the diagnosis of pericardial effusion and tamponade physiology. Ultrasound guidance for pericardiocentesis is currently considered the standard of care. Several approaches have been described recently, which differ mainly on the site of puncture (subxiphoid, apical, or parasternal). Although they share the use of low-frequency probes, there is absence of complete control of needle trajectory and real-time needle visualization. An in-plane and real-time technique has only been described anecdotally. Methods and results A retrospective analysis of 11 patients (63% men, mean age: 37.7±21.2 years) presenting with cardiac tamponade admitted to the tertiary-care emergency department and treated with parasternal medial-to-lateral in-plane pericardiocentesis was carried out. The underlying causes of cardiac tamponade were different among the population. All the pericardiocentesis were successfully performed in the emergency department, without complications, relieving the hemodynamic instability. The mean time taken to perform the eight-step procedure was 309±76.4 s, with no procedure-related complications. Conclusion The parasternal medial-to-lateral in-plane pericardiocentesis is a new technique theoretically free of complications and it enables real-time monitoring of needle trajectory. For the first time, a pericardiocentesis approach with a medial-to-lateral needle trajectory and real-time, in-plane, needle visualization was performed in a tamponade patient population.
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Maggiolini S, De Carlini CC, Imazio M. Evolution of the pericardiocentesis technique. J Cardiovasc Med (Hagerstown) 2018; 19:267-273. [PMID: 29553993 DOI: 10.2459/jcm.0000000000000649] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: Pericardiocentesis is a valuable technique for the diagnosis and treatment of patients with pericardial effusion and cardiac tamponade, although it may be associated with potentially serious complications. Through the years, many different imaging approaches have been described to reduce the complication rate of the procedure. This systematic review provides a focused overview of the different techniques developed in recent years to reduce the procedural complications and to increase the related success rate.
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Affiliation(s)
- Stefano Maggiolini
- Cardiology Division, Cardiovascular Department, San L. Mandic Hospital, Merate
| | | | - Massimo Imazio
- Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, Torino, Italy
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Kızıltunç E, Ünlü S, Yakıcı İE, Kundi H, Korkmaz A, Çetin M, Örnek E. Clinical characteristics and prognosis of cardiac tamponade patients: 5‑year experience at a tertiary center. Herz 2018; 45:676-683. [PMID: 30470911 DOI: 10.1007/s00059-018-4769-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/06/2018] [Accepted: 10/29/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Cardiac tamponade (CT) is characterized by compression of the cardiac chambers due to pericardial fluid accumulation. The etiology and prognosis may vary in different regions, and thus patient series from various regions can be useful for exploring the etiological and prognostic disparities. The aim of this study was to determine the clinical characteristics of patients with imminent CT, to evaluate the diagnostic performance of biochemical, microbiologic, and pathologic laboratory analysis, and to ascertain the prognosis of CT patients. METHODS We enrolled all patients with imminent CT who underwent percutaneous pericardiocentesis between July 2012 and December 2017 in this retrospective study. The patients were classified into three etiology groups: (a) malignancy (MRCT); (b) iatrogenic/mechanical complication of myocardial infarction (IMCT); and (c) other causes (OCT). Clinical information, laboratory findings, and survival data were recorded. RESULTS In total, 186 pericardiocentesis procedures were performed on 153 consecutive patients with CT. The median follow-up was 137 days (range: 1-1937). The MRCT group had the highest mortality rate (79%) in 12 months, while the OCT group had the lowest rate (27%). We determined that increased age, higher serum urea levels, and malignancy-related CT were independent predictors of mortality. The mortality rates of the MRCT and IMCT groups were similar, with both of them being significantly higher than the rate of the OCT group. In all, 15 patients were diagnosed with a new malignancy via pericardial fluid cytology. CONCLUSION Patients in the MRCT and IMCT groups had a poor prognosis. The presence of malignancy was found to be the most powerful predictor of mortality in CT patients.
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Affiliation(s)
- E Kızıltunç
- Cardiology Department, Numune Education and Research Hospital, 06100, Ankara, Turkey.
| | - S Ünlü
- Cardiology Department, Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - İ E Yakıcı
- Cardiology Department, Numune Education and Research Hospital, 06100, Ankara, Turkey
| | - H Kundi
- Cardiology Department, Numune Education and Research Hospital, 06100, Ankara, Turkey.,Cardiology Department, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - A Korkmaz
- Cardiology Department, Numune Education and Research Hospital, 06100, Ankara, Turkey
| | - M Çetin
- Cardiology Department, Numune Education and Research Hospital, 06100, Ankara, Turkey
| | - E Örnek
- Cardiology Department, Numune Education and Research Hospital, 06100, Ankara, Turkey
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Sethi A, Singbal Y, Kodumuri V, Prasad V. Inpatient mortality and its predictors after pericardiocentesis: An analysis from the Nationwide Inpatient Sample 2009-2013. J Interv Cardiol 2018; 31:815-825. [PMID: 30259579 DOI: 10.1111/joic.12563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND National registries have provided data on in-hospital outcomes for several cardiac procedures. The available data on in-hospital outcomes and its predictors after pericardiocentesis are mostly derived from single center studies. Furthermore, the outcomes after pericardiocentesis for iatrogenic pericardial effusion and the impact of procedural volume on in-hospital outcomes in the United States are largely unknown. METHODS We used national inpatient database files for the years 2009-2013 to estimate the inpatient outcomes after pericardiocentesis in all-comers and in the subgroups with iatrogenic effusion. We also studied the impact of hospital procedural volume, among other predictors, on inpatient mortality. RESULTS About 64,070 (95%CI 61 008-67 051) pericardiocentesis were performed in the United States during 2009-2013. Of these, 57.15% (56.02-58.26%) of the pericardiocentesis were in hemodynamically unstable patients. Percutaneous cardiac procedures were performed in 17.7% of patients (percutaneous coronary intervention (PCI) 4.02%, electrophysiologic procedures 13.58%, and structural heart intervention (SHI) 0.76%). Overall inpatient mortality was 12.30% (95%CI 11.66-12.96%). Inpatient mortality after PCI, electrophysiologic procedures, SHI and cardiac surgery were 27.67% (95%CI 24-31.67%), 7.8% (95%CI 6.67-9.31%), 22.36% (95%CI 15.06-31.85%) and 18.97% (95%CI 15.84-22.57%), respectively. There was an inverse association between hospital procedural volume and inpatient mortality, with a mortality of 14.01% (12.84-15.26%) at the lowest and 10.82% (9.44-12.37%) at highest quartile hospitals by procedure volume (ptrend = 0.001). CONCLUSION The inpatient mortality after pericardiocentesis is high, particularly when associated with PCI and SHI.
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Affiliation(s)
- Ankur Sethi
- RutgersRobert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Yash Singbal
- Department of Cardiology University of Queensland, Brisbane, Australia
| | - Vamsi Kodumuri
- Department of Cardiology, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Vinoy Prasad
- Department of Cardiology, Loma Linda University, Loma Linda, California
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Maggiolini S, Gentile G, Farina A, De Carlini CC, Lenatti L, Meles E, Achilli F, Tempesta A, Brucato A, Imazio M. Safety, Efficacy, and Complications of Pericardiocentesis by Real-Time Echo-Monitored Procedure. Am J Cardiol 2016; 117:1369-74. [PMID: 26956635 DOI: 10.1016/j.amjcard.2016.01.043] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/18/2016] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
Abstract
Pericardiocentesis is useful in the diagnosis and treatment of pericardial effusive disease. To date, a number of methods have been developed to reduce complications and increase the success rate of the procedure. The aim of the present study was to evaluate the efficacy and the safety of echocardiography-guided pericardiocentesis under continuous echocardiographic monitoring in the management of pericardial effusion. We prospectively performed 161 pericardiocentesis procedures in 141 patients admitted from 1993 to 2015 in 3 centers. This procedure was performed for tamponade or large pericardial effusion in 157 cases and for diagnosis in 4 cases. A percutaneous puncture was performed where the largest amount of fluid was detected. To perform a real-time echo-guided procedure, a multi-angle bracket was mounted on the echocardiographic probe to support the needle and enable its continuous visualization during the puncture. The procedure was successful in 160 of 161 cases (99%). Two major complications occurred (1.2%): 1 mediastinal hematoma that required surgical drainage in a patient on anticoagulant therapy and 1 pleuropericardial shunt requiring thoracentesis. Seven minor complications occurred (4.3%): 1 pleuropericardial shunt, 1 case of transient AV type III block, 3 vasovagal reactions (1 with syncope), and 2 cases of acute pulmonary edema managed with medical therapy. No punctures of any cardiac chamber occurred, and emergency surgical drainage was not required in any case. In conclusion, echocardiography-guided pericardiocentesis under continuous visualization is effective, safe, and easy to perform, even in hospitals with low volumes of procedures with or without cardiac surgery.
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