What is Pericardiocentesis?
A pericardiocentesis can remove excess fluid around the heart. The buildup of fluid in the heart lining is called pericardial effusion.
This can cause pressure on the heart leading to dyspnea (shortness of breath) and coughing. The accumulation of too much fluid is dangerous because it can interfere with the heart working.
This is 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.
In the past, this procedure was risky. But now that doctors can use ultrasound to guide them, it’s much safer. Pericardiocentesis is not the only way to get rid of fluid around the heart, but it’s usually chosen over surgery.
Benefits for Mesothelioma Patients
This procedure can ease symptoms and improve quality of life. Mesothelioma symptoms may improve after the procedure. These include shortness of breath, coughing and chest pressure.
Pericardial effusion can complicate cases of pleural and peritoneal mesothelioma. They can also occur in the very rare primary pericardial mesothelioma cases.
A 2021 study of a pericardial patient noted that pericardial fluid did not contain malignant cells. The diagnosis is 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
When having a pericardiocentesis, you’ll have it done in the hospital. It may happen in a special room for surgery, or a lab where they check your heart with special tools. 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.
A doctor or other healthcare provider will clean an area near your chest and give you medicine to make it numb. 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
A patient with recurrent pericardial effusions may receive several pericardiocentesis procedures. A chest X-ray and echocardiography can be used to detect recurring pericardial effusions.
CT scans are sometimes capable of detecting pericardial mesothelioma tumors. They often fail to detect diffuse mesothelioma tumors. They 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.