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33.9 Interventional therapies for pericardial diseases
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Published:July 2018
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Abstract
The prerequisite for interventional therapies in pericardial diseases is a meticulous clinical work-up of the patient including all necessary imaging modalities, and the assessment of the aetiology if needed. Interventional procedures include pericardiocentesis, life-saving acute drainage in tamponade, prolonged drainage in selected cases, intrapericardial medical therapy, percutaneous balloon pericardiotomy, or percutaneous pericardiostomy. Echocardiography and fluoroscopy guidance have greatly increased safety. Current major complications occur in less than 2% of cases with no mortality in experienced centres. To facilitate pericardial access in patients with very small or no effusion, several devices have been tested, which are not routinely needed. Assessment of the underlying disorder has been improved by cytology and pericardial and epicardial biopsy under pericardioscopy guidance. Intrapericardial therapy with fibrinolytics can facilitate complete drainage of dense or loculated pericardial effusions in purulent, tuberculous, or uraemic pericarditis in addition to extensive rinsing. In neoplastic pericardial effusions, intrapericardial cytostatic treatment can effectively prevent recurrences of effusions although the lethal outcome from the underlying cancer can only be delayed. In autoreactive pericardial effusions, intrapericardial triamcinolone prevents further recurrences with only a few systemic corticoid side effects. Percutaneous balloon pericardiotomy can be an alternative to surgical pericardial fenestration. Symptomatic pericardial cysts can be eradicated by alcohol instillations. Epicardial ablation of arrhythmogenic foci in (peri)myocardial disease has become available for the interventional pericardiologist and rhythmologist.
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