Systematic review of percutaneous interventions for malignant pericardial effusion

Abstract

The present systematic review assessed the safety and efficacy of percutaneous interventions for malignant pericardial effusion (MPE), with primary endpoint of recurrence of pericardial effusion. Electronic searches of six databases identified thirty-one studies, reporting outcomes following isolated pericardiocentesis (n=305), pericardiocentesis followed by extended catheter drainage (n=486), pericardial instillation of sclerosing agents (n=392) or percutaneous balloon pericardiotomy (PBP) (n=157). Isolated pericardiocentesis demonstrated a pooled recurrence rate of 38.3%. Pooled recurrence rates for extended catheter drainage, pericardial sclerosis and PBP were 12.1%, 10.8% and 10.3%, respectively. Procedure-related mortality ranged from 0.5-1.0% across the percutaneous interventions. Although isolated pericardiocentesis can safely deliver immediate symptomatic relief, subsequent catheter drainage or sclerotherapy are required to minimize recurrence. PBP has been shown to be highly effective and may be particularly useful in managing recurrent effusions. Ultimately, the choice of intervention must be based on the clinical status of patients, their underlying malignancy and the expertise available.

SCAI Expert consensus statement: Evaluation, management, and special considerations of cardio‐oncology patients in the cardiac catheterization laboratory (endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologıa intervencionista)

“…The subxiphoid is the standard approach. A dilating balloon containing 30% radiographic contrast medium is advanced over the guide wire to the pericardial border and it is manually inflated to create the window . Post‐procedure echocardiography and chest radiography are recommended to monitor for possible re‐accumulation of pericardial fluid or development of an iatrogenic left pleural effusion.…”

Total electrical alternans in a patient with malignant pericardial tamponade

“…Furthermore, the occurrence of cardiac tamponade, in contrast to the general population is relatively common in patients with malignant pericardial effusion, has a poor prognosis and a patient remain at risk for recurrence of tamponade following pericardiocentesis 11. In cases with reduced life expectancy, surgical interventions such as a pericardial window can be considered in patients with symptomatic effusions in whom medical therapy and repeated pericardiocentesis were not successful 7.…”

Emergencies in Lung Cancer

“…İşlem sonrası hızlı rekürrens malign efüzyonlarda sık görülen bir problemdir (15,16,18) . Son yayınlarda rekürrens oranı %38 civarında olduğu bildirilmiştir (19) . Perkütan balon perikardiyotomi perikardiyal efüzyon yönetiminde cerrahi olmayan bir tedavi sunar.…”