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Echo-guided pericardiocentesis.

• The echocardiographic 2D exam allows the correct identification of location and severeity of the pericardial effusion before pericardial puncture.
• Saline infusion (echocontrast) during 2D monitoring of pericardiocentesis allows to identify the position of the tip of the catheter / needle and thus to reduce the risk of cardiac perforation (Figure 71).
• The monitoring with 2D and Doppler echocardiography allows to identify regression of tamponade and hemodynamic normalization, and to identify any residual effusion.

Susini G et al. Percutaneous pericardiocentesis versus subxiphoid pericardiotomy in cardiac tamponade due to postoperative pericardial effusion. J Cardiothorac Vasc Anesth 1993;2:178.

Figure 73-75. Severe pericardial effusion and tamponade before pericardiocentesis (Fig. 73); complete systolic collapse of the RA is seen. Resolution of tamponade during pericardiocentesis (Fig. 74): no collapse of the RA wall (only systolic contraction). Fig 75: residual effusion post-pericardiocentesis.

Figures 76-77. Resolution of complete RA wall collapse (Fig. 76, double white arrow) after initial drainage of 100 ml with pericardiocentesis (Fig. 77). Residual large effusion (PE).

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Mayo Clinic experience (Tsang et al, Chest 1999;116:322).