Pericardiocentesis

For patients with pericardial mesothelioma or pleural mesothelioma that has spread to the heart, a pericardiocentesis is often recommended to alleviate symptoms. This procedure is used to treat pericardial effusion, the buildup of fluid in the pericardium, the sac that envelopes the heart. It is sometimes referred to as a pericardial tap.

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The buildup of fluid in the heart lining can cause painful pressure on the heart, chest pain, dyspnea (shortness of breath) and coughing. This procedure can effectively remove fluid buildup to relieve these symptoms.

Though the way pericardiocentesis is performed has changed over the years, it is actually a very old procedure, first introduced in the mid-1800s. By the 1900s, it was the preferred method of treatment for patients suffering from pericardial effusion caused by a variety of diseases, including cancer, and it was (and is) also used for diagnostic purposes. However, a pericardial mesothelioma diagnosis cannot be confirmed with diagnostic testing of pericardial fluid because the fluid rarely contains malignant cells when mesothelioma is present.

Early procedures carried many risks, but once technology was in place to allow doctors performing the procedure to be guided by ultrasound, it became much safer.

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About the Procedure

Generally, the procedure is performed in the hospital, either in a surgical setting such as a cardiac catheterization lab or, if the patient is already hospitalized, at bedside. Fasting for six hours prior to the procedure may be requested, as well as abstaining from drinking. Patients are often set up with an IV in case any medications or fluids are deemed necessary during the procedure.

The anesthesiologist (or other health care worker) then cleans an area just below the breastbone, and a local anesthetic is administered. A long, thin needle is then gently guided into the pericardial sac in order to draw out fluid. Echocardiography (an ultrasound of the heart) is used to help guide the position of the needle and ensure there is no injury to the heart.

Once the needle is correctly in place, it is removed and replaced with a catheter tube. The catheter drains the fluid into containers, usually for several hours.

Some patients feel pressure when the needle enters, and some people may experience chest pain, which is treatable with pain medication. Patients may also benefit from pain medication after the anesthesia has worn off.

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The patient will be monitored for several hours after the procedure is complete to ensure there are no complications. Potential problems that can occur during or after pericardiocentesis might include a puncture in the heart, cardiac arrest, heart attack or the inducement of an irregular heart rhythm.

The procedure may need to be performed more than once, especially if fluid continues to accumulate in the area.

Recurrent Pericardial Effusion

Several pericardiocentesis procedures may be performed on a patient with recurrent pericardial effusions. A chest X-ray and echocardiography can be used to detect recurring pericardial effusions, but they lack sensitivity to detect pericardial tumors. CT scans are sometimes capable of detecting pericardial mesothelioma tumors, though they frequently fail to detect diffuse mesothelioma tumors, which grow in a diffused pattern throughout the pericardium rather than as a solid mass.

Diagnostic testing of the fluid extracted, called effusion cytology, is commonly performed after each procedure. Effusion cytology reveals malignant cells in approximately 20 percent of cases when mesothelioma is present.

In most cases of primary pericardial mesothelioma, confirmation of diagnosis usually requires a biopsy of the tumor. A pericardiectomy surgery is required to obtain a biopsy. This surgery can also relieve pericardial effusion and may prevent recurrence of effusion.

Benefits for Mesothelioma Patients

Doctors recommend the pericardiocentesis procedure to patients with pericardial effusion to ease symptoms and improve quality of life. Symptoms that may improve after the procedure include shortness of breath, coughing and chest pain, all common symptoms of mesothelioma cancer.

Although a pericardiocentesis cannot lead to a definitive diagnosis of pericardial mesothelioma, it can effectively treat symptoms of the cancer.

Additional Resources

  1. Chahinian, A.P. (2005). Clinical presentation and natural history of mesothelioma: Pleural and pericardial. In Pass, H.I., Vogelzang, N.J. & Carbone, M. (Eds.), Malignant Mesothelioma (380-390). New York: Springer.
  2. Khandaker, M.H., Espinosa, R.E., Nishimura, R.A., Sinak, L.J., Hayes, S.N., Melduni, R.M., & Oh, J.K. (2010). Pericardial disease: Diagnosis and management. Mayo Clinic Proceedings, 85(6): 571-593. doi: 10.4065/mcp.2010.0046
  3. MedlinePlus. (2012, Jun. 7). Pericardiocentesis. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/003872.htm
  4. Medscape. (2013, Feb. 5). Pericardiocentesis. Retrieved from http://emedicine.medscape.com/article/80602-overview
  5. National Cancer Institute. (2011, Jun 30). Malignant pericardial effusion. Retrieved from http://www.cancer.gov/cancertopics/pdq/supportivecare/cardiopulmonary/HealthProfessional/page4
  6. Thomason, R., Schlegel, W., Lucca, M., Cummings, S., & Lee, S. (1994). Primary malignant mesothelioma of the pericardium: Case report and literature review. Texas Heart Institute Journal, 21(2): 170-174. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC325154/
  7. Tsang, T., Freeman, W., Sinak, L., & Seward, J. (1998). Echogardiographically guided pericardiocentesis: Evolution and state-of-the-art technique. Mayo Clinic Proceedings, 73(7): 647-652. Retrieved from http://www.sciencedirect.com/science/article/pii/S002561961164888X
  8. WebMD. (2012, Feb. 29). Heart Disease and Pericardiocentesis. Retrieved from http://www.webmd.com/heart-disease/guide/pericardiocentesis

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