Technical and Prognostic Outcomes of Double-Balloon Pericardiotomy for Large Malignancy-Related Pericardial Effusions

Pericardial Disease

“…An attractive alternative in these patients, especially if their overall prognosis is poor from the malignancy, is the percutaneous creation of a pericardial window by balloon dilation. 52,53 …”

Controversial Issues in the Management of Pericardial Diseases

“…70 Less invasive options for recurrent symptomatic effusions are derived mainly from experience in the management of neoplastic pericardial effusions and include prolonged catheter drainage and the creation of the so-called "pericardial window." [71][72][73][74][75][76] In patients with cardiac tamponade or significant effusion, initial relief can easily be obtained with percutaneous pericardiocentesis followed sometimes by drainage with an indwelling catheter. Prolonged catheter drainage is an effective means of preventing fluid reaccumulation, although the mechanism by which this occurs is probably related more to the obliteration of the pericardial space after inflammation provoked by the catheter than to fluid drainage itself.…”

“…Reported complications include fever (up to 28%), pneumothorax or need for a chest tube (up to 20%), and rarely bleeding from a pericardial blood vessel. 75,76 Key points: (1) Pericardiectomy is recommended for persistent constrictive pericarditis; (2) patients with newly diagnosed constrictive pericarditis who are hemodynamically stable may be given a trial of conservative management (antiinflammatory therapy with NSAIDs and/or corticosteroids) for 2 to 3 months before pericardiectomy is recommended; and (3) pericardiectomy is almost never indicated for recurrent pericarditis except for patients with repeated recurrences with cardiac tamponade and those with evidence of serious steroid toxicity, although other approaches may be equally effective and less invasive (eg, pericardial window by either conventional heart surgery or video-assisted thoracoscopy).…”

A randomised trial of intrapericardial bleomycin for malignant pericardial effusion with lung cancer (JCOG9811)

“…Recently, less invasive techniques for surgical treatment of MPE have been described, such as percutaneous balloon pericardiotomy (Ziskind et al, 1993;Wang et al, 2002), which create a pleuro-pericardial communication and allow fluid drainage into pleural space. It was reported to be effective and safe, and may potentially obviate the need for surgical intervention.…”