Anatomic Approach and Outcomes in Children Undergoing Percutaneous Pericardiocentesis.
Myers F, Aggarwal V, Bass JL, Berry JM, Knutson S, Narasimhan S, Steinberger J, Ambrose M, Shah KM, Hiremath G.
Pediatr Cardiol. 2021 Feb 16. doi: 10.1007/s00246-021-02563-8. Online ahead of print.
PMID: 33590324
Take Home Points:
- Percutaneous echocardiography-guided pericardiocentesis can be performed safely from a variety of anatomical approaches.
- Non-subxiphoid approaches are associated with shorter procedure times.
- The exact approach should be tailored to the clinical characteristics and operator experience.
Commentary from Dr. Konstantin Averin (Edmonton), catheterization section editor of Pediatric Cardiology Journal Watch: Pericardiocentesis is a routine procedure that is traditionally performed via a subxiphoid approach. A variety of other anatomic approaches have been described. Data regarding the safety and efficacy of non-subxiphoid approaches in children are lacking. The authors report on procedural and short-term single center outcomes from a variety of anatomic approaches to performing pericardiocentesis.
From August, 2008 to December, 2019 104 patients – median age 52 months (15.6-133.4) and median weight 16.4 kg (10.4-37) – underwent percutaneous pericardiocentesis to drain effusions from a variety of causes (post-hematopoietic stem cell transplant was most common, 53%). All patients had echocardiographic guidance utilized. A non-subxiphoid approach was slightly more common than subxiphoid (58.6% v 41.4%) – figure below details the different approaches. The non-subxyphoid approach resulted in shorter procedure times (21 v 37 min, p=0.005) and was performed in larger (23.6 v 11.2 kg, p=0.013) and older patients (95.9 v 21.7 months, p = 0.006). There were no significant complications in either group.
The authors conclude that percutaneous pericardiocentesis can be performed safely from a variety of anatomical approaches. Echocardiographic guidance can facilitate the performance of this procedure, especially from non-traditional approaches. Non-subxiphoid approaches are associated with shorter procedure time but ultimately the exact approach should be tailored to the clinical characteristics (i.e. location of fluid) and operator experience.
