pierre-Yves René Marcy DO, Presenter: Nothing to Disclose

Pierre-Yves Bondiau MD, Abstract Co-Author: Nothing to Disclose

Frederic Peyrade MD, Abstract Co-Author: Nothing to Disclose

Sebastien Novellas MD, Abstract Co-Author: Nothing to Disclose

Remy Largillier MD, Abstract Co-Author: Nothing to Disclose

Jean- Claude Gallard, Abstract Co-Author: Nothing to Disclose

-To describe the emergency cardiac tamponade.-To describe the anatomic pathways used to drain percutaneously the pericardial sac.-To report our experience of US- guided percutaneous pericardial drainage using the paraxiphoid approach.

43 cancer patients, mean age 59y (range, 21-81) demonstrated signs of Beck's triad, i.e., raised central venous pressure with hypotension [systolic blood pressure was 98 +/-25mmHg with a mean heart rate of 1O9 bpm [91-199] before the procedure, and a quiet heart on auscultation. Electrocardiogram showed low voltage (100%), and QRS alternation in 18 patients. Echocardiography demonstrated mild to large pericardial effusion. Pericardial drainage was attempted under US guidance using the paraxiphoid route ("Larey" route).

In 35/42 cases, percutaneous needle pericardiocentesis was successfully performed using the subxiphoid approach. The 18G-sheathed needle was inserted between the xiphoid process and the left costal margin. Once pericardium has been breached, the steel core was withdrawn leaving the sheath into the pericardial space. Systolic blood pressure increased up to 128+/- 25mmHg with a mean heart rate of 96bpm (79-143).Minor complications occured in 11% (transient arrhythmia, right ventricular puncture). Fluid was mostly hemorrhagic (>90%) and cytology findings were positive for malignancy in 97%. Mean amount of drained fluid was 750cc. In 7 patients, the "Larey route" was not feasible because of colonic interposition (n=2), left hepatomegaly (n=2), previous pneumonectomy (n=2) and large epigastric varices.

Emergency needle pericardiocentesis is safer than blind procedures.Technical success rate is 83% in cancer patients. Other options include the US- guided apical approach (the needle is aimed internally instead of toward the left shoulder) and the CT- guided lateral approach.Right pleural drainage may be performed, whenever possible, before pericardiocentesis attempt in order to decrease the tamponade like effect.Initial pericardial drainage has to be limited to 200-400mL in the first twenty min after catheter placement to prevent hemodynamic compromise from the sudden release of pericardial pressure.

Marcy, p, Bondiau, P, Peyrade, F, Novellas, S, Largillier, R, Gallard, J, US-guided Percutaneous Pericardial Drainage Using the Larey Route.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4416480.html