Percutaneous balloon pericardiotomy for recurrent malignant pericardial effusion.

摘要

An 82-year-old woman with stage 3 non-small cell lung cancer presented with a large pericardial effusion demonstrated by transthoracic echocardiography (TTE) (Figure 1, white arrow) (Supplemental Digital Content 1, http://links.lww.com/JTO/A157). She had a history of previous pericardial effusion treated with pericardiocentesis. She was evaluated and deemed high risk for definitive surgical treatment. Therefore, she underwent percutaneous balloon pericardiotomy, performed from a subxiphisternal approach under aseptic technique with fluoroscopic and echocardiographic guidance (Figures 2A-D) (Supplemental Digital Content 2-4, http://links.lww.com/JTO/A1578, http://links.lww.com/JTO/A160, and http://links.lww.com/ JT0/A161). Six hundred milliliters of serous fluid was aspirated, resulting in immediate symptomatic improvement. Three months later, TTE revealed a small stable effusion with no diastolic right atrium/right ventricle/collapse.Malignant disease is a common cause of pericardial effusion with incidences ranging from 1 to 20% in all cancer patients. Management is challenging with recurrence rates of 13 to 50% after pericardiocentesis and patients often unsuitable for surgical intervention. Percutaneous balloon pericardiotomy is a simple and safe minimally invasive alternative to drain pericardial effusions.