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.
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.