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What is Pericardiocentesis?
The buildup of fluid in the heart lining is known as pericardial effusion. This can cause pressure on the heart leading to dyspnea (shortness of breath) and coughing. The accumulation of too much fluid in the pericardial sac can be very dangerous because it can interfere with the heart working effectively. A pericardiocentesis can effectively remove fluid excess to relieve these symptoms.
Although the way pericardiocentesis is performed has changed over the years, it is actually an old procedure that was 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 disease.
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. Pericardiocentesis is not the only procedure that drains fluid around the heart, but it is generally preferred over invasive surgery.
Benefits for Mesothelioma Patients
Doctors recommend the pericardiocentesis procedure to mesothelioma patients with pericardial effusion to ease symptoms and improve quality of life. Mesothelioma symptoms, including shortness of breath, coughing and chest pressure, may improve after the procedure. Pericardial effusion can complicate cases of pleural and peritoneal mesothelioma. They can also occur in the very rare primary pericardial mesothelioma cases.
A 2021 case study of a pericardial mesothelioma patient noted that while pericardial effusion was present, the fluid did not contain malignant cells. The study noted that diagnosis for this rare disease is especially difficult because tumor invasion of the myocardium may not appear on radiological imaging.
Although a pericardiocentesis cannot usually lead to a definitive diagnosis of pericardial mesothelioma, it can effectively treat symptoms of the cancer and potentially prevent further fluid buildup in the pericardium.
What to Expect from a Pericardiocentesis
Generally, a pericardiocentesis is performed in the hospital, either in a surgical setting, a cardiac catheterization lab or bedside if the patient is already hospitalized. Avoiding eating or drinking for six or more hours prior to the procedure may be requested.
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 below the breastbone and administers a local anesthetic. A long, thin needle is then gently guided into the pericardial sac to draw out fluid. An echocardiogram, which is an ultrasound of the heart, is used to guide 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, sometimes for several hours or possibly overnight.
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 wears off.
Recovery from Pericardiocentesis
You should ask your doctor about what to expect after a pericardiocentesis. In general, you should be able to resume normal activities relatively soon after the procedure. However, you should avoid strenuous exercise or physical activity until your doctor says it is OK to do so.
An additional echocardiogram may be used to confirm the absence of fluid reaccumulation. An X-ray may also be ordered to ensure the needle did not puncture your lungs. Your medical team will closely monitor your vital signs such as your heart rate, breathing and blood and oxygen levels.
After leaving the hospital, you should contact your doctor immediately if you experience increased draining from the needle insertion site, chest pain or severe symptoms.
Risks of Pericardiocentesis for Mesothelioma
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 include:
- A puncture in the heart
- Cardiac arrest
- Abnormal heart rhythms
- Puncturing the liver
- Excess bleeding
- Air in the chest cavity
- Infection around the procedure site
These complications are rare and may vary depending on your age, overall health and the severity of the pericardial effusion being treated. 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.
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. Doctors continue using pericardiocentesis for diagnostic purposes. However, the procedure is diagnostic in only 25% of pericardial mesothelioma cases, according to a 2016 study from Hindawi’s Case Reports in Medicine.
Pericardial mesothelioma is rare and difficult to diagnose. Pericardial fluid does not usually contain malignant cells when mesothelioma is present.
In most cases of primary pericardial mesothelioma, confirmation of diagnosis usually requires a biopsy of the tumor. A pericardiectomy is required to obtain a biopsy. This surgery can also relieve pericardial effusion and may prevent recurrence of effusion.
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