The paucity of abnormal physical or echocardiographic signs of tamponade in breathless patients with pericardial effusion does not exclude symptomatic benefit being derived from pericardiocentesis. Pericardial aspiration is safe in appropriate hands, although aspiration of loculated effusions may not be as successful as aspiration of non-loculated effusions.

Summary:Congenital left ventricular diverticula are a rare cause of sudden cardiac death. We describe the first reported case of ventricular fibrillation in association with congenital diverticula of the heart. The diagnosis of left ventricular diverticula was made by cardiac catheterization and confirmed by magnetic resonance imaging. Treatment was initiated with anti-arrhythmic and anticoagulant drugs to prevent life-threatening arrhythmias and emboli.

We determined the clinical value of routine transthoracic echocardiography performed after catheter ablation of supraventricular tachyarrhythmias in children. Between April 1996 and December 2003, 253 children, of whom 135 male, with the overall group having a median age of 9, ranging from 0.1 to 19 years, underwent 280 uncomplicated radiofrequency catheter ablation procedures for supraventricular tachyarrhythmias at three institutions. In every child, transthoracic Doppler echocardiography was performed before and after the procedure. The pre-ablation transthoracic echocardiograms were normal in all, and this was one of the criterions for inclusion. The post-ablation echocardiogram showed a disorder in four asymptomatic patients. In one patient, with focal atrial tachycardia, ablated via a retrograde aortic approach, there was mild aortic valvar insufficiency. This had resolved 6 months later. Pericardial effusions developed in 3 other children. In 2 the effusions resolved spontaneously but 1 patient required pericardial drainage. This same patient also developed clinically asymptomatic mild aortic insufficiency, which resolved spontaneously within 6 months. Routine echocardiography after uncomplicated catheter ablation procedures is of clinical value, and is especially indicated when a retrograde aortic approach has been used.

Pneumopericardium is rare in acute asthma and cardiac tamponade has not been reported. The case is reported of a 20 year old asthmatic patient in whom assisted ventilation and high airway pressures resulted in tension pneumopericardium with clinical signs of cardiac tamponade that were relieved by pericardial aspiration.Cardiac tamponade is usually caused by the accumulation of blood or other fluid within the pericardial sac. Much rarer is the association of pneumopericardium with cardiac tamponade. We report cardiac tamponade resulting from pneumopericardium in a patient receiving assisted ventilation for severe asthma. Case reportA 20 year old asthmatic woman presented with a week long history of worsening asthma. On admission she was tachypnoeic with severe central cyanosis. Her heart rate was 120/min and blood pressure 130/80 mm Hg with appreciable pulsus paradoxus. Her chest was hyperexpanded, with widespread inspiratory and expiratory wheeze. Chest radiography showed no evidence of pneumothorax. While she was breathing high concentration oxygen her arterial blood gas measurements were: pH 6-8, Po2 8.8 kPa, Pco2 After 18 hours' ventilation the patient's condition deteriorated suddenly. Her heart rate increased from 90 to 120 beats/min and her blood pressure fell from 120/80 to 50 (systolic) mm Hg. Central venous pressure rose from + 15 to +40cm H20. The clinical picture was compatible with cardiac tamponade and chest radiography showed a large pneumopericardium (figure).A 16 gauge teflon central venous cannula was introduced into the pericardial sac via the subxiphisternal route by an aseptic technique. One litre of air was aspirated and the cannula connected to underwater seal drainage. A rapid response was observed, with restoration of heart rate and blood pressure to their former levels. Two hours later the patient developed a left tension pneumothorax and a chest drain was inserted via the left axilla. Shortly afterwards a right tension pneumothorax appeared, and this too was drained successfully.