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Percutaneous Balloon Pericardiotomy for Recurrent Malignant Pericardial Effusion

  • Daniel A. Jones
    Correspondence
    Address for correspondence: Daniel A. Jones, MBBS, BSc, Department of Cardiology, London Chest Hospital, Bonner Road, Bethnal Green, London E2 9JX, United Kingdom.
    Affiliations
    NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, United Kingdom

    Department of Cardiology, Barts and the London NHS Trust, London, United Kingdom.
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  • Ajay K. Jain
    Affiliations
    NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, United Kingdom

    Department of Cardiology, Barts and the London NHS Trust, London, United Kingdom.
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      An 82-year-old woman with stage 3 non-small cell lung cancer presented with a large pericardial effusion demonstrated by transthoracic echocardiography (TTE) (Figure 1, white arrow) (Supplemental Digital Content 1, http://links.lww.com/JTO/A157). She had a history of previous pericardial effusion treated with pericardiocentesis. She was evaluated and deemed high risk for definitive surgical treatment. Therefore, she underwent percutaneous balloon pericardiotomy, performed from a subxiphisternal approach under aseptic technique with fluoroscopic and echocardiographic guidance (Figures 2A–D) (Supplemental Digital Content 2–4, http://links.lww.com/JTO/A158, http://links.lww.com/JTO/A160, and http://links.lww.com/JTO/A161). Six hundred milliliters of serous fluid was aspirated, resulting in immediate symptomatic improvement. Three months later, TTE revealed a small stable effusion with no diastolic right atrium/right ventricle/collapse.
      Figure thumbnail gr1
      FIGURE 1.Transthoracic echocardiogram showing large global pericardial effusion (white arrows). RV, right ventricle; LV, left ventricle.
      Figure thumbnail gr2
      FIGURE 2.Fluoroscopic images detailing the percutaneous balloon pericardiotomy procedure from confirmation of position using contrast (A); Inoue balloon used to dilate the pericardial space inflated repeatedly until the waist of the pericardium over the balloon was lost with consequential decrease in effusion size (B–D).
      Malignant disease is a common cause of pericardial effusion with incidences ranging from 1 to 20% in all cancer patients.
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      Cardiac lymphatic involvement by metastatic tumour.
      • Lockwood WB
      • Broghamer Jr, WL
      The changing prevalence of secondary cardiac neoplasms as related to cardiac therapy.
      Management is challenging with recurrence rates of 13 to 50%
      • Galli M
      • Politi A
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      Percutaneous balloon pericardiotomy for malignant pericardial tamponade.
      after pericardiocentesis and patients often unsuitable for surgical intervention. Percutaneous balloon pericardiotomy is a simple and safe minimally invasive alternative to drain pericardial effusions.

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