Interventional Pericardiology

Foreword Preface Acknowledgments Authors 1. A Historical Perspective 1.1. Introduction 1.2. Diagnostic and therapeutic pericardial interventions 1.2.1. Pericardiocentesis and pericardial drainage 1.2.2. Pericardioscopy 1.2.3. Pericardial biopsy 1.2.4. Percutaneous balloon pericardiotomy 1.2.5. Intrapericardial treatment of pericardial disease 1.2.6. Intrapericardial treatment of non-pericardial disease 1.3. Future perspectives and recommendations 2. Anatomy of the Pericardium Relevant for Pericardial Access, Pericardioscopy, and Intrapericardial Interventions 2.1. Introduction 2.2. Structures of the normal pericardium 2.2.1. Pericardial sinuses and recesses 2.2.2. Epicardial and pericardial fat 2.2.3. Normal pericardial fluid 2.2.4. Nerves, arteries, lymphatics, and lymph nodes 2.3. Pericardial anomalies 2.4. Distinction between the human and animal pericardium 2.5. Future perspectives and recommendations 3. Pericardial Effusion and Cardiac Tamponade 3.1. Introduction 3.2. Clinical presentation of cardiac tamponade 3.3. Physical findings in cardiac tamponade 3.3.1. Pulsus paradoxus 3.4. Electrocardiogram in cardiac tamponade 3.5. Chest radiography 3.6. Echocardiography 3.7. Cardiac catheterization and invasive hemodynamics 3.8. Medical management of cardiac tamponade 3.9. Future perspectives and recommendations 4. Pericardial Access and Drainage: Standard Techniques 4.1. Introduction 4.2. Indications for pericardial drainage 4.3. Emergency pericardiocentesis 4.4. Echocardiography-guided pericardiocentesis 4.4.1. Evolution of echo-guided pericardiocentesis 4.4.2. Safety and efficacy of echo-guided pericardiocentesis 4.4.3. Reduction of effusion recurrence with catheter drainage 4.4.4. Technique of state-ofthe-art echo-guided pericardiocentesis 4.5. Pericardiocentesis guided by fluoroscopy 4.5.1. Feasibility of fluroscopy guided pericardiocentesis 4.5.2. The role of cardiac catheterization during pericardiocentesis 4.5.3. Safety of fluoroscopy guided pericardiocentesis 4.6. Surgical drainage of the pericardium 4.7. Future perspectives and recommendations 5. Alternative Techniques for Pericardiocentesis 5.1. Introduction 5.2. Pericardiocentesis guided by epicardial halo phenomenon 5.2.1. Physical origin of the sign 5.2.2. Tangential approach to the pericardial surface 5.2.3. Feasibility and safety 5.2.4. Clinical implications 5.3. PerDUCER technique 5.3.1. Endoscopic guidance in patients with perimyocarditis 5.3.2. PerDUCER procedure in patients with moderate/large effusions 5.3.3. Potential improvements of the procedure 5.4. PeriAttacher and AttachGuider 5.5. Pericardial access using a blunt-tip needle 5.6. Transbronchial approach 5.7. Computer guided pericardiocentesis 5.8. Pericardiocentesis guided by computed tomography 5.9. Pericardiocentesis guided by a pacing capture 5.10. Future perspectives and recommendations 6. Pericardiocentesis in the Absence of Effusion 6.1. Introduction 6.2. Subxiphoid pericardiocentesis using a Tuohy needle and fluoroscopy 6.2.1. Technique and potential complications 6.2.2. Feasibility and safety 6.2.3. Limitations of the approach 6.3. The PerDUCER technique 6.3.1. Experimental experience 6.3.2. Access of the human pericardium in the absence of effusion using PerDUCER 6.4. Pericardial access via trans-atrial approach 6.4.1. Catheter system with a pre-mounted needle 6.4.2. Streamlined catheter system 6.4.3. Safety of the transatrial approach 6.4.4. Study limitations 6.4.5. Clinical implications 6.5. Right ventricular approach 6.6. Future perspectives and recommendations 7. Diagnostic Value of Pericardial Fluid Analyses 7.1. Introduction 7.2. Volume and appearance of pericardial effusion 7.3. Pericardial fluid cytology 7.3.1. Number of specimens needed for pericardial fluid cytology 7.3.2. Detection of malignancy by pericardial fluid cytology 7.3.3. Reactive mesothelial vs. adenocarcinoma cells 7.3.4. Prognostic and therapeutic implications 7.3.5. Paramalignant pericardial effusion 7.3.