Percutaneous balloon pericardiotomy for the treatment of recurrent malignant pericardial effusion

Malignant disease with pericardial metastasis is one of the most common causes of recurrent pericardial effusion (PE) with tamponade. While surgical pericardiotomy in these patients is very morbid and may not be a viable option, a palliative treatment percutaneously with percutaneous balloon pericardiotomy (PBP) can be a preferred treatment. We report herewith a case of PBP technique done using our day-to-day catheterisation laboratory equipment.     

Percutaneous balloon pericardiotomy in patients with recurrent pericardial effusion]

BACKGROUND: Recurrent symptomatic pericardial effusion can complicate different cardiac and extracardiac diseases. When recurrent pericardial effusion after drainage with conventional catheter techniques occurred the creation of a pericardial window by open surgery used to be the unique treatment available until the recent development of percutaneous balloon pericardiotomy. OBJECTIVE: The aim of this paper is to review our initial experience with percutaneous balloon pericardiotomy for the treatment of patients with recurrent pericardial effusion. PATIENTS AND METHOD: Five patients with recurrent pericardial effusion have been treated with percutaneous pericardiotomy until now. Four patients had malignant pericardial effusion secondary to metastasis of extracardiac tumors, in one patient recurrent pericardial effusion was idiopathic. In all patients percutaneous balloon pericardiotomy was performed with a pediatric valvuloplasty balloon catheter, through a subxiphoid approach. RESULTS: Successful drainage and balloon pericardiotomy was achieved in all patients without severe complications. In all cases only one pericardial site was dilated. Minor complications were registered, which included mainly mild pleural effusion occurring in all patients with spontaneous resolution. During a mean follow-up period of 8.6 6.5 months (range 2 to 18 months) there were no recurrences of effusion or tamponade. Two patients died, 1 month and 9 months after the procedure, due to their malignant condition. CONCLUSIONS: Percutaneous balloon pericardiotomy is an easy and useful technique to manage patients with large recurrent pericardial effusion with a low r     

Primary percutaneous balloon pericardiotomy for malignant pericardial effusion

Objectives : Pericardial effusion associated with malignancy is a life‐threatening complication of late‐stage disease. While simple drainage is effective in relieving the symptoms, reaccumulation of effusion may cause further symptomatic episodes, often during a period when overall patient management is focused on improving the quality of remaining life. Over a 16‐year period, we have adopted a strategy of managing such patients with balloon pericardiotomy as the initial preferred treatment. The results are described and compared to alternative management strategies. Methods : A retrospective analysis of patients who presented with symptomatic, malignant pericardial effusion, their management, procedural complication rates, and the need for further therapy for the same condition was made. Survival, reaccumulation rates, and readmissions after the index procedure were recorded and compared. Results : Forty‐three patients were treated for malignant pericardial effusion. Balloon pericardiotomy was the primary treatment in 27/43 patients, simple drainage in 14/43, and surgery in 2/43. Reaccumulation rates between balloon pericardiotomy and simple aspiration (7.4% vs. 14.3%, respectively, P = 0.48) and complication rates (7.4% vs. 7.1%, respectively, P = 0.98) were not statistically different. Survival following intervention was driven by the underlying pathology and was poor, with overall median survival of 56 days. Conclusions : Balloon pericardiotomy, as initial management of symptomatic malignant pericardial effusions, allows a definitive procedure to be performed at presentation. This can be achieved with low complication rates, similar to treatment by simple drainage. © 2008 Wiley‐Liss, Inc.     

Case report: Percutaneous balloon pericardiotomy using Inoue balloon for patients with massive pericardial effusion

Two patients presenting with huge pericardial effusion were treated with pericardiotomy, using an Inoue balloon dilating catheter, to prevent recurrences and achieve symptoms relief. The procedure is a modification of an original technique reported by Palacios et al. gaining advantage of the Inoue balloon self positioning abilities and low profile. No early recurrence was observed. In both cases the effect was excellent and lead to quick ambulation sparing the patients the risk of more aggressive surgical procedure and general anesthesia. It is concluded that percutaneous balloon pericardiotomy supported by the Inoue balloon unique versatility is a simple and safe way to drain massive pericardial effusions.     

Percutaneous balloon pericardial window for patients with malignant pericardial effusion and tamponade

We performed percutaneous balloon pericardial window (PBPW) in 8 patients (age 40 to 70 yrs; 4 men, 4 women) with malignant pericardial effusion and tamponade. Pericardial window was indicated because they continued to drain >100 ml/day of pericardial fluid through the pigtail catheter for >/3 days. A 0.038 inch guidewire was advanced through the pigtail catheter into the pericardial space and then the catheter was removed. A 20 mm diameter, 3 cm long balloon dilating catheter was advanced to straddle the parietal pericardium. Manual inflations were performed until the waist produced by the pericardium disappeared. All patients tolerated the procedure well with minimal discomfort and with no complications. A left or bilateral pleural effusion occurred in all patients after PBPW. No patient developed recurrent pericardial tamponade at a mean follow-up of 6 ± 2 months. Thus, PBPW is a useful and safe technique to avoid surgery in patients with malignant pericardial effusion and tamponade.     

Percutaneous balloon pericardiotomy for the treatment of infected pericardial effusion with tamponade

Percutaneous balloon pericardiotomy has been used as an alternative for surgically created pericardial window mainly for the management of malignant pericardial effusions in critically ill patients. We describe a patient with purulent pericardial effusion and cardiac tamponade who was treated successfully and without complications with percutaneous balloon pericardiotomy.     

Percutaneous balloon pericardiotomy in the management of recurrent malignant pericardial effusions

Two patients with recurrent symptomatic pericardial effusions secondary to malignant disease were successfully treated by percutaneous balloon pericardiotomy. Open surgery was avoided and the procedure was completed under local anaesthesia in less than 40 minutes. The first patient was free of recurrence at nine months but pericardial effusion recurred at two months in the second patient.Percutaneous balloon pericardiotomy offers a potentially important new means of relieving recurrent tamponade and substantially reduces trauma to the patient.     

Percutaneous balloon pericardiotomy in the management of recurrent malignant pericardial effusions

Two patients with recurrent symptomatic pericardial effusions secondary to malignant disease were successfully treated by percutaneous balloon pericardiotomy. Open surgery was avoided and the procedure was completed under local anaesthesia in less than 40 minutes. The first patient was free of recurrence at nine months but pericardial effusion recurred at two months in the second patient.

Percutaneous balloon pericardiotomy offers a potentially important new means of relieving recurrent tamponade and substantially reduces trauma to the patient.

     

Percutaneous balloon pericardiotomy in the management of recurrent malignant pericardial effusions.

Two patients with recurrent symptomatic pericardial effusions secondary to malignant disease were successfully treated by percutaneous balloon pericardiotomy. Open surgery was avoided and the procedure was completed under local anaesthesia in less than 40 minutes. The first patient was free of recurrence at nine months but pericardial effusion recurred at two months in the second patient. Percutaneous balloon pericardiotomy offers a potentially important new means of relieving recurrent tamponade and substantially reduces trauma to the patient.     

Percutaneous balloon pericardiotomy in a patient with end stage renal disease with recurrent pericardial effusion & pericardial tamponade

A case report of 37-year-old female with end stage renal disease presented with recurrent pericardial effusion and cardiac tamponade, who underwent percutaneous balloon pericardiotomy using an Inoue balloon dilating catheter, to create a non-surgical pericardial window. The procedure of non-surgical pericardial window is safe and effective alternative to conventional more invasive surgical pericardial window. It is concluded that percutaneous balloon pericardiotomy is helpful in the management of massive pericardial effusions particularly in patients with chronic renal failure and poor clinical condition.     

Percutaneous balloon pericardiotomy: A double-balloon technique

We describe a double-balloon technique for performing a percutaneous balloon pericardiotomy. This technique was employed when the large, single dilation balloon customarily used for this procedure failed to fully inflate across the parietal pericardium. Two smaller balloons were advanced through the same skin tract and simultaneously inflated, thus producing an adequate pericardial window. This double-balloon technique allowed for the more secure anchoring of the balloons across the pericardium and for the delivery of greater dilation pressures. © 1995 Wiley-Liss, Inc.     

Predictors of mortality within three months in the patients with malignant pleural effusion

BackgroundMalignant pleural effusion (MPE) has a limited life expectancy (3–12 months). We investigated the predictors of the early mortality (EM) within three months.MethodsThe patients were retrospectively grouped according to the death within three months (Group I) and survival more than three months (Group II). Demographical, clinical, and biochemical parameters in the fluid were analysed to determine their effects on the EM. The 30-day response rate of talc pleurodesis was investigated.ResultsThe study included 85 patients (Group I/Group II = 40/45). The patients in Group I died within a median of 28 days. Twenty-six patients in Group II died in a median of 205, but 19 were still alive (median 200 days). The median survival was longer in renal cell, colorectal, breast, liver, ovarian and oropharynx carcinoma, and mesothelioma. Sixty-two patients (63%) underwent talc pleurodesis, which prevented the fluid reaccumulation (p = 0.04). The significant factors of the EM in the univariate analysis were the presence of high-risk tumors (lung, stomach, soft tissue, bladder, esophagus, prostate, cervix, and lymphoma), the low Karnofsky performance score (KPS) (p < 0.0001), the low pH value of the fluid (p = 0.05), and the low concentration of glucose (p = 0.01), total protein (p < 0.0001), and albumin (p < 0.0001) in the fluid. According to the multivariate analysis high-risk tumors (p = 0.03), a lower KPS (p < 0.001), and glucose value (p = 0.04) were the predictors of the EM.ConclusionTalc pleurodesis prevents the fluid reaccumulation. High-risk tumors, a poor performance status, and lower pleural fluid glucose concentration are predictors of the EM within three months in the patients with a MPE.     

Efficacy of percutaneous balloon pericardiotomy and intrapericardial instillation for the management of refractory pericardial effusion: a case report

Percutaneous balloon pericardiotomy and intrapericardial instillation seemed to be less invasive and effective treatments for refractory pericardial effusion. A 65-year-old man who suffered from refractory pericardial effusion associated with gastric cancer and had been hospitalized three times for pericardiocentesis, complained of dyspnea at rest and visited our emergency room. Echocardiography showed a large amount of pericardial effusion all around the heart and signs of cardiac tamponade. Percutaneous balloon pericardiotomy was performed and pericardial effusion turned to pleural effusion. We performed left thoracocentesis. One week later, massive pericardial effusion localized only around the right heart appeared, and pericardiocentesis was performed again. After another month, pericardial effusion around right heart appeared again and intrapericardial instillation with OK-432 (Picibanil) was tried. After the procedure, the pericardial effusion did not increase, and he has had few symptoms for 2 months as an outpatient.     

Percutaneous balloon pericardiotomy for the treatment of large,nonmalignant pericardial effusions in children: Immediate and medium-term results

To evaluate the safety and efficacy of pericardial window creation by percutaneous balloon dilation in children with recurrent, symptomatic, nonmalignant pericardial effusion, 6 boys and 4 girls, age 5–12 yr, underwent the procedure using the subxiphoid approach. The procedure was successful in 9 patients. There was one case with rupture of the balloon and entrapment of its distal part within the pericardium. During follow-up (mean 14.6 mo) there was reaccumulation of fluid only in the patient in whom rupture of the balloon had occurred. No other complications were noted. Thus, percutaneous balloon pericardiotomy appears to be a safe and effective technique for the creation of a pericardial window in children with nonmalignant pericardial effusions, and may be used as an alternative to surgical window creation. Cathet Cardiovasc Diagn 40:97–100, 1997 © 1997 Wiley-Liss, Inc.     

贝伐单抗局部应用治疗恶性胸腹水的 meta 分析

目的：贝伐单抗是抑制血管内皮生长因子受体(vascular endothelial growth factor receptor,VEGF)的重组人源化抗体,本研究旨在系统评价腹腔局部应用贝伐单抗联合化疗治疗恶性胸腹水的疗效及安全性。方法计算机检索中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、维普数据库(VIP)、万方数据库、The Cochrane Library、PubMed、EMBASE 及 SCI 等数据库,收集有关贝伐单抗联合化疗治疗恶性胸腹水的随机对照试验(randomized control trial,RCT);主要结局指标包括有效率、完全缓解(complete remission,CR)、部分缓解(partial remission,PR)、毒性反应;采用比值比(odds ratio,OR ),95%可信区间(95% CI )表示,Review Manager5.0统计软件进行 meta 分析。结果共纳入6项 RCT,共330例伴有恶性胸腹水患者,meta 分析结果显示,与单纯化疗方案比较,腹腔局部注射贝伐单抗联合化疗方案较化疗单药可提高恶性胸腹水治疗有效率(OR =0.23,95% CI ：0.13~0.39,P <0.05),描述性分析发现贝伐单抗局部应用并未增加其它毒性反应的发生率。结论化疗基础上贝伐单抗局部注射可以明显缓解或控制恶性胸腹水,且该治疗方案没有增加不良反应,安全性可靠。     

Intrapericardial cisplatin for the management of patients with large malignant pericardial effusion

Nine patients (seven men and two women), median age 57 years (range 40–68 years), with large malignant pericardial effusion confirmed by cytological examination, were treated with direct intrapericardial administration of cisplatin. After insertion of a polyurethane catheter, fluid was drained and cisplatin (10 mg in 20 ml normal saline) was instilled over 5 min during 5 consecutive days (total cisplatin dose: 50 mg). If fluid reaccumulation occurred the courses were repeated every 3 weeks. All of the patients achieved a complete therapeutic response (no more fluid reaccumulation). The median time of response was 2.8 months (range 1–24 months). Mild nausea occurred in two patients, supraventricular arrythmia in one patient and infectious complications in one patient. Eight patients died because of disease progression without evidence of cardiac tamponade or stricture. Autopsy, performed in 7 cases, revealed neoplastic involvement of the pericardium in all of the patients, but pericardial effusion was seen in one patient only.     

胸腔积液生物标志物对结核性和恶性胸腔积液的鉴别价值

胸腔积液是一种常见的胸部疾病或并发症,可因多种疾病状态所致。病因上,可为原发胸膜的疾病,也可继发于心、肝、肾、肺、纵隔、脾、卵巢、结缔组织病以及血液系统等疾病;疾病类型包括肿瘤、感染性疾病、器官功能障碍和全身性疾病等,其中心力衰竭、恶性肿瘤、肺炎和结核所致胸腔积液占所有病例的3/4。根据Light标准,胸腔积液可分为渗出性和漏出性胸腔积液(分别简称为渗出液和漏出液)。漏出液患者多存在全身严重基础疾病,如充血性心力衰竭、肝硬化、肾病综合征、心包疾病等;渗出液的病因则更为复杂,以结核性胸腔积液(tuberculous pleural effusion,TPE)和恶性胸腔积液(malignant pleural effusion,MPE)最为常见。     

结核性胸腔积液与恶性胸腔积液患者危险因素的对比研究

目的 探索结核性胸腔积液与恶性胸腔积液患者危险因素的不同,为临床个体化诊治胸腔积液提供依据。 方法 连续性入选2006年1月至2012年12月间在青岛市中心医院呼吸科确诊为结核性胸腔积液或恶性胸腔积液的患者264例,其中结核性胸腔积液患者147例,恶性胸腔积液患者117例。调查并比较两组患者的年龄、性别、合并糖尿病、呼吸系统基础疾病史、经济状况、工作劳累感、群体居住行为、运动量不足、进食规律性、睡眠时间、心理应激程度、吸烟指数、类似病家族史等13个项目,采用logistic单因素和多因素回归分析,对结核性胸腔积液和恶性胸腔积液的发病独立危险因素进行对比,以说明两者危险因素的差异。 结果 单因素分析结果显示,结核性胸腔积液与恶性胸腔积液两组数据比较,合并糖尿病［15.0%（22/147）vs 6.8%（8/117）,χ²=4.571,P=0.034］、经济状况差［38.1%（56/147）vs 29.9%（35/117）,χ²=5.103,P=0.028］、有群体居住行为［29.3%（43/147） vs 9.4%（11/117）,χ²=4.977,P=0.030］,是结核性胸腔积液的危险因素;年龄＞40岁［45.6%（67/147）vs 78.6%（92/117）,χ²=4.752,P=0.032］、心理应激程度高［15.0%（22/147）vs 33.3%（39/117）,χ²=6.031,P=0.017］、吸烟指数＞400［25.9%（38/147）vs 32.5%（38/117）,χ²=5.228,P=0.024］和有类似病家族史［9.5%（14/147）vs 34.2%（40/117）,χ²=3.976,P=0.046］是恶性胸腔积液的危险因素。在排除其他因素影响后,合并糖尿病（χ²=5.391,P=0.027,OR=2.457,95%CI：5.051～1.773）和群体居住行为（χ²=5.491,P=0.022,OR=3.636,95%CI：6.494～2.584）仍然是结核性胸腔积液的危险因素;年龄＞40岁（χ²=5.364,P=0.022,OR=2.323,95%CI：1.197～2.588）和有类似病家族史（χ²=5.897,P=0.021,OR=3.080,95%CI：2.233～4.018）是恶性胸腔积液危险因素。 结论 胸腔积液患者如果合并糖尿病或有群体居住行为更容易出现结核性胸腔积液,如果年龄＞40岁或有类似病家族史,更容易出现恶性胸腔积液。     

Follow-up study of 100 malignant pleural mesotheliomas

One hundred malignant pleural mesotheliomas have been treated in our hospital since 1955. Clinical and autopsy findings are analyzed and compared to X-ray changes. The most common symptoms were dyspnea (49%), pain (40%) and cough (36%). The main initial X-ray signs were pleural effusion (62%), pleural thickening (29%) and solitary nodules (6%). Prior to death a combination of effusion and pleural thickening was the usual finding. Histologically there were 49 biphasic, 32 mesenchymal and 18 epithelial malignant pleural mesotheliomas. At autopsy 82% of the cases had distant metastases, most of which had not been expected clinically. The median survival time was 7.3 months following the first clinical symptoms, and only 4 months after the first radiological signs.