Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

Pericardial Effusion and Pericardiocentesis: Role of Echocardiography

  • Jung, Hae-Ok (Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea)
  • Published : 2012.11.30
⟨ Previous Next ⟩

Abstract

Pericardial effusion can develop from any pericardial disease, including pericarditis and several systemic disorders, such as malignancies, pulmonary tuberculosis, chronic renal failure, thyroid diseases, and autoimmune diseases. The causes of large pericardial effusion requiring invasive pericardiocentesis may vary according to the time, country, and hospital. Transthoracic echocardiography is the most important tool for diagnosis, grading, the pericardiocentesis procedure, and follow up of pericardial effusion. Cardiac tamponade is a kind of cardiogenic shock and medical emergency. Clinicians should understand the tamponade physiology, especially because it can develop without large pericardial effusion. In addition, clinicians should correlate the echocardiographic findings of tamponade, such as right ventricular collapse, right atrial collapse, and respiratory variation of mitral and tricuspid flow, with clinical signs of clinical tamponade, such as hypotension or pulsus paradoxus. Percutaneous pericardiocentesis has been the most useful procedure in many cases of large pericardial effusion, cardiac tamponade, or pericardial effusion of unknown etiology. The procedure should be performed with the guidance of echocardiography.

Keywords

References

  1. Little WC, Freeman GL. Pericardial disease. Circulation 2006;113:1622-32. https://doi.org/10.1161/CIRCULATIONAHA.105.561514
  2. Braunwalt E. Pericardial disease. In: Fausi AS, Braunwalt E, Kasper DL, et al. editors. Harrison's internal medicine. 17th ed. New York: McGraw Hill Medical;2008. p.1488-92.
  3. Oh JK, Seward JB, Tajik AJ. Pericardial diseases. In: Oh JK, Seward JB, Tajik AJ editors. The echo manual. 3rd ed. Philadelphia: Lippincott Williams and Wilkins (Wolters Kluwers);2007. p.289-92.
  4. Munt BI, Moss RR, Grewal J. Pericardial disease. In: Otto CM editor. The practice of clinical echocardiography. 4th ed. Philadelphia: Saunders/Elservier;2011. p.565-78.
  5. Manning WJ. Pericardial disease. In: Goldman L, Ausiello D editors. Cecil Medicine. 23rd ed. Philadelphia: Saunders/Elservier;2008. p.548-52.
  6. Sagrista-Sauleda J, Merce AS, Soler-Soler J. Diagnosis and management of pericardial effusion. World J Cardiol 2011;3:135-43. https://doi.org/10.4330/wjc.v3.i5.135
  7. Maisch B, Seferovic PM, Ristic AD, et al. Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. Eur Heart J 2004;25:587-610. https://doi.org/10.1016/j.ehj.2004.02.002
  8. Kil UH, Jung HO, Koh YS, et al. Prognosis of large, symptomatic pericardial effusion treated by echo-guided percutaneous pericardiocentesis. Clin Cardiol 2008;31:531-7. https://doi.org/10.1002/clc.20305
  9. Cho BC, Kang SM, Kim DH, et al. Clinical and echocardiographic characteristics of pericardial effusion in patients who underwent echocardiographically guided pericardiocentesis: Yonsei Cardiovascular Center experience, 1993-2003. Yonsei Med J 2004;45:462-8. https://doi.org/10.3349/ymj.2004.45.3.462
  10. Kim DY, Park JH, Shin JD, et al. Long-term follow-up results and clinical manifestations of patients with a moderate to large amount of pericardial effusion. Korean J Med 2008;74:154-61.
  11. Tsang TS, Enriquez-Sarano M, Freeman WK, et al. Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and outcomes spanning 21 years. Mayo Clin Proc 2002;77:429-36. https://doi.org/10.1016/S0025-6196(11)62211-8
  12. Kabukcu M, Demircioglu F, Yanik E, Basarici I, Ersel F. Pericardial tamponade and large pericardial effusions: causal factors and efficacy of percutaneous catheter drainage in 50 patients. Tex Heart Inst J 2004;31:398-403.
  13. Sagrista-Sauleda J, Merce J, Permanyer-Miralda G, Soler-Soler J. Clinical clues to the causes of large pericardial effusions. Am J Med 2000;109:95-101. https://doi.org/10.1016/S0002-9343(00)00459-9
  14. Levy PY, Corey R, Berger P, et al. Etiologic diagnosis of 204 pericardial effusions. Medicine (Baltimore) 2003;82:385-91. https://doi.org/10.1097/01.md.0000101574.54295.73
  15. Reuter H, Burgess LJ, Doubell AF. Epidemiology of pericardial effusions at a large academic hospital in South Africa. Epidemiol Infect 2005;133:393-9. https://doi.org/10.1017/S0950268804003577
  16. Horowitz MS, Schultz CS, Stinson EB, Harrison DC, Popp RL. Sensitivity and specificity of echocardiographic diagnosis of pericardial effusion. Circulation 1974;50:239-47. https://doi.org/10.1161/01.CIR.50.2.239
  17. Pepi M, Muratori M. Echocardiography in the diagnosis and management of pericardial disease. J Cardiovasc Med (Hagerstown) 2006;7:533-44. https://doi.org/10.2459/01.JCM.0000234772.73454.57
  18. Jung HO, Seung KB, Madias JE. Electrocardiographic changes resulting from pericardial effusion drainage. Am J Cardiol 2010;106:437-41. https://doi.org/10.1016/j.amjcard.2010.03.044
  19. Verhaert D, Gabriel RS, Johnston D, Lytle BW, Desai MY, Klein AL. The role of multimodality imaging in the management of pericardial disease. Circ Cardiovasc Imaging 2010;3:333-43. https://doi.org/10.1161/CIRCIMAGING.109.921791
  20. Spodick DH. Acute cardiac tamponade. N Engl J Med 2003;349:684-90. https://doi.org/10.1056/NEJMra022643
  21. Ariyarajah V, Spodick DH. Cardiac tamponade revisited: a postmortem look at a cautionary case. Tex Heart Inst J 2007;34:347-51.
  22. Kronzon I, Cohen ML, Winer HE. Cardiac tamponade by loculated pericardial hematoma: limitations of M-mode echocardiography. J Am Coll Cardiol 1983;1:913-5. https://doi.org/10.1016/S0735-1097(83)80208-3
  23. Tsang TS, Barnes ME, Hayes SN, et al. Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes of echo-guided pericardiocentesis for management: Mayo Clinic experience, 1979-1998. Chest 1999;116:322-31. https://doi.org/10.1378/chest.116.2.322
  24. Singh S, Wann LS, Schuchard GH, et al. Right ventricular and right atrial collapse in patients with cardiac tamponade--a combined echocardiographic and hemodynamic study. Circulation 1984;70:966-71. https://doi.org/10.1161/01.CIR.70.6.966
  25. Gillam LD, Guyer DE, Gibson TC, King ME, Marshall JE, Weyman AE. Hydrodynamic compression of the right atrium: a new echocardiographic sign of cardiac tamponade. Circulation 1983;68:294-301. https://doi.org/10.1161/01.CIR.68.2.294
  26. Kochar GS, Jacobs LE, Kotler MN. Right atrial compression in postoperative cardiac patients: detection by transesophageal echocardiography. J Am Coll Cardiol 1990;16:511-6. https://doi.org/10.1016/0735-1097(90)90613-T
  27. Gaffney FA, Keller AM, Peshock RM, Lin JC, Firth BG. Pathophysiologic mechanisms of cardiac tamponade and pulsus alternans shown by echocardiography. Am J Cardiol 1984;53:1662-6. https://doi.org/10.1016/0002-9149(84)90598-8
  28. Armstrong WF, Schilt BF, Helper DJ, Dillon JC, Feigenbaum H. Diastolic collapse of the right ventricle with cardiac tamponade: an echocardiographic study. Circulation 1982;65:1491-6. https://doi.org/10.1161/01.CIR.65.7.1491
  29. Engel PJ, Hon H, Fowler NO, Plummer S. Echocardiographic study of right ventricular wall motion in cardiac tamponade. Am J Cardiol 1982;50:1018-21. https://doi.org/10.1016/0002-9149(82)90411-8
  30. Reydel B, Spodick DH. Frequency and significance of chamber collapses during cardiac tamponade. Am Heart J 1990;119:1160-3. https://doi.org/10.1016/S0002-8703(05)80248-0
  31. Appleton CP, Hatle LK, Popp RL. Cardiac tamponade and pericardial effusion: respiratory variation in transvalvular flow velocities studied by Doppler echocardiography. J Am Coll Cardiol 1988;11:1020-30. https://doi.org/10.1016/S0735-1097(98)90060-2
  32. Burstow DJ, Oh JK, Bailey KR, Seward JB, Tajik AJ. Cardiac tamponade: characteristic Doppler observations. Mayo Clin Proc 1989;64:312-24. https://doi.org/10.1016/S0025-6196(12)65251-3
  33. Himelman RB, Kircher B, Rockey DC, Schiller NB. Inferior vena cava plethora with blunted respiratory response: a sensitive echocardiographic sign of cardiac tamponade. J Am Coll Cardiol 1988;12:1470-7. https://doi.org/10.1016/S0735-1097(88)80011-1
  34. Merce J, Sagrista-Sauleda J, Permanyer-Miralda G, Evangelista A, Soler-Soler J. Correlation between clinical and Doppler echocardiographic findings in patients with moderate and large pericardial effusion: implications for the diagnosis of cardiac tamponade. Am Heart J 1999;138(4 Pt 1):759-64. https://doi.org/10.1016/S0002-8703(99)70193-6
  35. Nagdev A, Stone MB. Point-of-care ultrasound evaluation of pericardial effusions: does this patient have cardiac tamponade? Resuscitation 2011;82:671-3. https://doi.org/10.1016/j.resuscitation.2011.02.004
  36. Tsang TS, Freeman WK, Barnes ME, Reeder GS, Packer DL, Seward JB. Rescue echocardiographically guided pericardiocentesis for cardiac perforation complicating catheter-based procedures. The Mayo Clinic experience. J Am Coll Cardiol 1998;32:1345-50. https://doi.org/10.1016/S0735-1097(98)00390-8
  37. Seferovic PM, Ristic AD, Imazio M, et al. Management strategies in pericardial emergencies. Herz 2006;31:891-900. https://doi.org/10.1007/s00059-006-2937-0
  38. Lindenberger M, Kjellberg M, Karlsson E, Wranne B. Pericardiocentesis guided by 2-D echocardiography: the method of choice for treatment of pericardial effusion. J Intern Med 2003;253:411-7. https://doi.org/10.1046/j.1365-2796.2003.01103.x
  39. Halpern DG, Argulian E, Briasoulis A, Chaudhry F, Aziz EF, Herzog E. A novel pericardial effusion scoring index to guide decision for drainage. Crit Pathw Cardiol 2012;11:85-8. https://doi.org/10.1097/HPC.0b013e318254a5ca
  40. Goodman A, Perera P, Mailhot T, Mandavia D. The role of bedside ultrasound in the diagnosis of pericardial effusion and cardiac tamponade. J Emerg Trauma Shock 2012;5:72-5. https://doi.org/10.4103/0974-2700.93118
  41. Loukas M, Walters A, Boon JM, Welch TP, Meiring JH, Abrahams PH. Pericardiocentesis: a clinical anatomy review. Clin Anat 2012;25:872-81. https://doi.org/10.1002/ca.22032
  42. Tsang TS, Freeman WK, Sinak LJ, Seward JB. Echocardiographically guided pericardiocentesis: evolution and state-of-the-art technique. Mayo Clin Proc 1998;73:647-52. https://doi.org/10.1016/S0025-6196(11)64888-X
  43. Spodick DH. Pericardial diseases. In: Braunwald E, Zipes DP, Libby P editors. Heart disease. 6th ed. Philadelphia, W.B. Saunders;2001. p.1823-76.
  44. Allen KB, Faber LP, Warren WH, Shaar CJ. Pericardial effusion: subxiphoid pericardiostomy versus percutaneous catheter drainage. Ann Thorac Surg 1999;67:437-40. https://doi.org/10.1016/S0003-4975(98)01192-8
  45. McDonald JM, Meyers BF, Guthrie TJ, Battafarano RJ, Cooper JD, Patterson GA. Comparison of open subxiphoid pericardial drainage with percutaneous catheter drainage for symptomatic pericardial effusion. Ann Thorac Surg 2003;76:811-5; discussion 816. https://doi.org/10.1016/S0003-4975(03)00665-9

Cited by

  1. Quantification of interstitial fluid on whole body CT: comparison with whole body autopsy vol.11, pp.4, 2012, https://doi.org/10.1007/s12024-015-9728-y
  2. Mechanics of pericardial effusion: A simulation study vol.229, pp.3, 2012, https://doi.org/10.1177/0954411915574012
  3. Point-of-Care Diagnosis of Cardiac Tamponade Identified by the Flow Velocity Paradoxus : Cardiac Tamponade and Flow Velocity Paradoxus vol.36, pp.11, 2017, https://doi.org/10.1002/jum.14251
  4. Yellow Nail Syndrome Presenting With a Pericardial Effusion: A Case Report and Review of the Literature vol.22, pp.2, 2012, https://doi.org/10.1177/1203475417738970
  5. Noninvasive Imaging of Pericardium vol.81, pp.2, 2020, https://doi.org/10.3348/jksr.2020.81.2.337
  6. Characteristic molecular signature of pericardial effusion identifies malignant cancer in pericardial disorder patients vol.16, pp.3, 2020, https://doi.org/10.1007/s13273-020-00076-8
  7. Association of pericardial effusion after pulmonary vein isolation and outcomes in patients with paroxysmal atrial fibrillation vol.43, pp.10, 2012, https://doi.org/10.1111/pace.14045
  8. Large Hypothyroidism-Induced Pericardial Effusion with Increased Serum Tumor Markers vol.96, pp.3, 2012, https://doi.org/10.3904/kjm.2021.96.3.241
  9. Low cardiac output syndrome requiring extracorporeal membrane oxygenation following pericardiocentesis in an adolescent with Hodgkin Lymphoma: a case report vol.36, pp.5, 2012, https://doi.org/10.1177/0267659120950604
  10. Role of immunosuppressive therapy in the management refractory postprocedural pericarditis vol.32, pp.8, 2012, https://doi.org/10.1111/jce.15069