Treatment of Complications

Pericardial Effusion

In patients with persistent pericardial effusion and/or clinical findings suggestive of infection or malignancy, echo guided pericardiocentesis is required for diagnosis and treatment. The procedure can be used to administer chemotherapeutic agents locally in patients who have neoplastic pericardial disease.

Cardiac Tamponade

The only effective treatment of cardiac tamponade is prompt drainage of the fluid from the pericardial space to relieve the compression of the cardiac chambers. The pericardial fluid can be drained by a needle pericardiocentesis or surgical pericardiotomy. When the fluid is highly viscous or loculated, pericardial drainage requires surgery. This may occur after cardiac surgery, when clotted blood may be present or when the pericarditis is due to a pyogenic organism.

Pericardiocentesis

Pericardiocentesis is a term used for needle drainage of the pericardial fluid. Echocardiography is helpful to locate and guide the pericardiocentesis needle. The ideal site for puncture is where the distance to the fluid is minimal, vascularity is minimal and no lung tissue is present. The subxiphoid approach is usually preferred over parasternal or apical sites of entry, as the risk of pneumothorax and coronary artery laceration are lower.