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Pediatric Cardiology

, Volume 37, Issue 7, pp 1328–1333 | Cite as

Novel, Long-axis In-plane Ultrasound-Guided Pericardiocentesis for Postoperative Pericardial Effusion Drainage

  • Mark A. Law
  • Santiago Borasino
  • Yuvraj Kalra
  • Jeffrey A. AltenEmail author
Original Article

Abstract

Pericardial effusion can be a life-threatening complication in children after cardiac surgery. Percutaneous pericardiocentesis is associated with rare, but serious complications. This retrospective study describes our experience with a novel, long-axis in-plane real-time ultrasound (US)-guided technique for postoperative pericardial effusion drainage in small children. Ten out of sixteen procedures were performed within 14 days of cardiac surgery at a median postoperative day 12 (IQR 2, 99). Median age was 2.7 months (IQR 0.4124) and weight 4.5 kg (IQR 2.5, 41.6). All but one procedure required a single attempt. Fourteen out of sixteen procedures had subxiphoid approach, and two were apical. Median initial drainage was 9 mL/kg (IQR 4.5, 27). Fifty percent of effusions were serous, 25 % chylous, and the remainder bloody. There were no reported complications. This study demonstrates a novel, long-axis pericardiocentesis technique that allows for an easy and safe needle entry into the pericardial space for small children in the early postoperative period.

Keywords

Ultrasound Pericardiocentesis Congenital heart disease Postoperative Neonate 

Notes

Funding

This study was funded by University of Alabama at Birmingham Department of Pediatric Cardiology funds.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This waiver was approved by the Institutional Review Board at the University of Alabama at Birmingham.

Supplementary material

Supplementary material 1 (AVI 6286 kb)

Supplementary material 2 (AVI 7059 kb)

References

  1. 1.
    Tsang TS, El-Najdawi EK, Seward JB, Hagler DJ, Freeman WK, O’Leary PW (2009) Percutaneous echocardiographically guided pericardiocentesis in pediatric patients. J Am Soc Echocardiogr 11(11):1072–1077CrossRefGoogle Scholar
  2. 2.
    Shabetui R (2003) The pericardium. Developments in cardiovascular medicine. Kluwêr Publishers, Norwell, p 168Google Scholar
  3. 3.
    Loukas M, Walters A, Boon JM, Welch TP, Meiring JH, Abrahams PH (2012) Pericardiocentesis: a clinical anatomy review. Clin Anat 25(7):877–881. doi: 10.1002/ca.22032 CrossRefGoogle Scholar
  4. 4.
    Lock JE, Bass JL, Kulik TJ, Fuhrman BP (1984) Chronic percutaneous pericardial drainage with modified pigtail catheters in children. Am J Cardiol 53(8):1179–1182CrossRefPubMedGoogle Scholar
  5. 5.
    Zahn EM, Houde C, Benson L, Freedom RM (1992) Percutaneous pericardial catheter drainage in childhood. Am J Cardiol 70(60):678–680CrossRefPubMedGoogle Scholar
  6. 6.
    Tsang TS, Barnes ME, Hayes SN, Freeman WK, Dearani JA, Butler SL, Seward JB (1999) Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes for echo-guided pericardiocentesis for management: Mayo clinic experience, 1979–1998. Chest 116(2):322–331CrossRefPubMedGoogle Scholar
  7. 7.
    Callahan JA, Seward JB, Nishimura RA, Miller FA Jr, Reeder GS, Shub C, Callahan MJ, Schattenberg TT, Tajik AS (1985) Two-dimensional echocardiographically guided pericardiocentesis: experience in 117 consecutive patients. Am J Cardiol 55(4):476–479CrossRefPubMedGoogle Scholar
  8. 8.
    Tsang TS, Freeman WK, Barnes ME, Reeder GS < Packer DL, Seward JB (1998) Rescue echocardiographically guided pericardiocentesis for cardiac perforation complicating catheter-based procedures. The mayo clinic experience. J Am Coll Cardiol 32(5):1345-1350Google Scholar
  9. 9.
    Tsang TS, Freeman WK, Sinak LJ, Seward JB (1998) Echocardiographically guided pericardiocentesis: evolution and State-of-the-Art technique. Mayo Clin Proc 73(7):647–652CrossRefPubMedGoogle Scholar
  10. 10.
    Bagri NK, Yadav DK, Agarwal S, Aier T, Gupta V (2014) Pericardial effusion in children: experience from tertiary care center in northern India. Indian Pediatr 51(3):211–213CrossRefPubMedGoogle Scholar
  11. 11.
    Medary I, Steinherz LJ, Aronson DC, La Quaglia MP (1996) Cardiac tamponade in the pediatric oncology population: treatment by percutaneous catheter drainage. J Pediatr Surg 31(1):197–199CrossRefPubMedGoogle Scholar
  12. 12.
    Silvestry FE, Kerber RE, Brook MM, Carroll JP, Eberman KM, Goldstein SA, Hermann HC, Homma S, Mehran R, Packer DL, Parisi AF, Pulerwitz T, Seward JB, Tsang TS, Wood MA (2009) Echocardiography-guided interventions. J Am Soc Echocardiogr 22(3):213–231CrossRefPubMedGoogle Scholar
  13. 13.
    Law MA, Borasino S, McMahon WS, Alten JA (2014) Ultrasound versus landmark-guided femoral catheterization in the pediatric catheterization laboratory: a randomized controlled trial. Pediatr Cardiol 35(7):1246–1252CrossRefPubMedGoogle Scholar
  14. 14.
    Alten JA, Borasino S, Gurley WQ, Law MA, Toms R, Dabal RJ (2012) Ultrasound-guided femoral vein catheterization in neonates with cardiac disease. Pediatr Crit Care Med 13:654–659CrossRefPubMedGoogle Scholar
  15. 15.
    Klein AL, Abbara S, Agler DA, Appleton CP, Asher CR, Hoit B, Hung J, Garcia MJ, Hung J, Garcia JM, Kronzon I, Oh JK, Rodriquez ER, Schaff HV, Schoenhagan P, Tan CD, White RD (2013) American society of echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: Endorsed by the society for cardiovascular magnetic resonance and society of cardiovascular computed tomography. J Am Soc Echocardiogr 26(9):965–1012. doi: 10.1016/j.echo.2013.06.023 CrossRefPubMedGoogle Scholar
  16. 16.
    Nagdev A, Mantuani D (2013) A novel in-plane technique for ultrasound-guided pericardiocentesis. Am J Emerg Med 31(9):1424-e5CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Mark A. Law
    • 1
  • Santiago Borasino
    • 2
  • Yuvraj Kalra
    • 2
  • Jeffrey A. Alten
    • 2
    Email author
  1. 1.Division of Pediatric CardiologyUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Section of Pediatric Cardiac Critical Care Medicine, UAB Pediatric Cardiac Critical Care MedicineUniversity of Alabama at BirminghamBirminghamUSA

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