Percutaneous Pericardial Catheter Drainage in Childhood Evan M. Zahn, MD, Christine Houde, MD, Lee Benson, MD, and Robert M. Freedom, MD
The clinical course of 41 consecutive pediatric patients (mean age 7.6 f 5.6 years, weight 27 f 22 kg) who underwent percutaneous pericardial drain placement during a 3-year period were reviewed. The most common diagnoses were malignancy (20%), postpericardiotomy syndrome (17%), aseptic pericarditis (12%), and patients recovering from a Fontan type of operation (12%). Indications for drainage ineluded increasing effusion sfze determhted by P-dimensional echocardiogram (48%), clinical deterioratkn (33%) and echocardiographfc evidence of hemodynamic compromise (12%). Only 3 (7%) patients had clinical evidence of cardiac tamponade. Drainage catheter placement was accomplished percutaneousfy from the subxiphoid approach. Insertion was successful in all but 1 patient (98%) and successful evacuation of the pericardial space was achieved in 93% of patients. There was 1 death in a critically ill 2-week&f infant and 4 compficatfons, 3 of which occurred in patients agod ‘/2 the diameter of the aortic root at the level of the aortic valve closure, corra sponding to grades 3 to 5 as defined by Beland et a1.7 Techniclue: All procedures were performed under fluoroscopic guidance using standard techniques.4v5 Use of electrocardiographic monitoring from the aspirating needle (lead VS) was decided upon by the individual cardiologists. The subxiphoid approach was used in all cases.Observing strict aseptic technique, the skin and subcutaneoustissueswere intiltrated with 1% lidocaine, and an 18 gauge needle was introduced at the left xiphocostal margin. Continuous needleaspiration was applied while advancing the needle.Entry into the pericardial spacewas marked by the appearanceof fluid in the syringe. Once within the pericardial space, a 70 cm long, 0.038-inch guidewire (Safe T-Jrm) was passed SEPTEMBER 1, 1992
through the needle into the pericardial sac. The needle was removed over the wire and replaced with a vessel dilator (1OFr) which was then replaced with a modified pigtail catheter (8Fr) (Cook Inc., Bloomington, Illinois). The catheter was positioned posteriorly along the lateral border of the heart. The entry site was covered with a dry sterile dressing and the catheter attached to suction (Pleurevac?) at a negative pressure of 10 to 20 cm of water continuously for the duration of the drainage period. Catheters were not routinely flushed with any solutions. All patients underwent 2-dimensional echocardiographic assessmentbefore and within 24 hours of catheter removal. StatMeal analysis: All data are expressedas mean f 1 standard deviation. A Student’s unpaired 2 tailed t test was used to examine the relation between catheter duration and quantity of drained fluid. Chi-square analysis was applied when comparing complications within age groups. A p value 3 days had a significantly greater amount of fluid drained (526 f 437 ml) at the time of pericardiocentesis than patients needing drainage for
The clinical course of 41 consecutive pediatric patients (mean age 7.6 f 5.6 years, weight 27 f 22 kg) who underwent percutaneous pericardial drain placement during a 3-year period were reviewed. The most common diagnoses were malignancy (20%), postpericardiotomy syndrome (17%), aseptic pericarditis (12%), and patients recovering from a Fontan type of operation (12%). Indications for drainage ineluded increasing effusion sfze determhted by P-dimensional echocardiogram (48%), clinical deterioratkn (33%) and echocardiographfc evidence of hemodynamic compromise (12%). Only 3 (7%) patients had clinical evidence of cardiac tamponade. Drainage catheter placement was accomplished percutaneousfy from the subxiphoid approach. Insertion was successful in all but 1 patient (98%) and successful evacuation of the pericardial space was achieved in 93% of patients. There was 1 death in a critically ill 2-week&f infant and 4 compficatfons, 3 of which occurred in patients agod ‘/2 the diameter of the aortic root at the level of the aortic valve closure, corra sponding to grades 3 to 5 as defined by Beland et a1.7 Techniclue: All procedures were performed under fluoroscopic guidance using standard techniques.4v5 Use of electrocardiographic monitoring from the aspirating needle (lead VS) was decided upon by the individual cardiologists. The subxiphoid approach was used in all cases.Observing strict aseptic technique, the skin and subcutaneoustissueswere intiltrated with 1% lidocaine, and an 18 gauge needle was introduced at the left xiphocostal margin. Continuous needleaspiration was applied while advancing the needle.Entry into the pericardial spacewas marked by the appearanceof fluid in the syringe. Once within the pericardial space, a 70 cm long, 0.038-inch guidewire (Safe T-Jrm) was passed SEPTEMBER 1, 1992
through the needle into the pericardial sac. The needle was removed over the wire and replaced with a vessel dilator (1OFr) which was then replaced with a modified pigtail catheter (8Fr) (Cook Inc., Bloomington, Illinois). The catheter was positioned posteriorly along the lateral border of the heart. The entry site was covered with a dry sterile dressing and the catheter attached to suction (Pleurevac?) at a negative pressure of 10 to 20 cm of water continuously for the duration of the drainage period. Catheters were not routinely flushed with any solutions. All patients underwent 2-dimensional echocardiographic assessmentbefore and within 24 hours of catheter removal. StatMeal analysis: All data are expressedas mean f 1 standard deviation. A Student’s unpaired 2 tailed t test was used to examine the relation between catheter duration and quantity of drained fluid. Chi-square analysis was applied when comparing complications within age groups. A p value 3 days had a significantly greater amount of fluid drained (526 f 437 ml) at the time of pericardiocentesis than patients needing drainage for
