Maggiolini S, Bozzano A, Russo P, Vitale G, Osculati G, Cantù E, Achilli F, Valagussa F
Cardiology Department, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano; Monza (MI), Italy.
J Am Soc Echocardiogr. 2001 Aug;14(8):821-4. doi: 10.1067/mje.2001.114009.
Fifty-three pericardiocentesis procedures were performed on 48 patients from 1993 to 2000 at our coronary care unit. Percutaneous puncture (anterior thoracic in 43 cases, subxiphoid in 10 cases) was performed at the site closest to the exploring probe, where the largest amount of fluid was detected. A needle carrier supported by a bracket with two fixed angulations was mounted on the probe. The needle was advanced through the tissues and inside the pericardial space under continuous visualization. The procedure was successful in 52 of 53 cases. In 1 case of diagnostic pericardiocentesis, the pericardial space was impossible to reach because of the minimal amount of pericardial fluid. In 1 case of acute tamponade after transcatheter ablation of the atrioventricular node, the pericardial puncture caused a pleural-pericardial shunt with consequent drainage of pericardial fluid into the pleural space and symptom resolution. In 1 case, a transient atrioventricular type III block occurred. Emergency surgical drainage was not required in any of the cases. No puncture of cardiac walls ever occurred in this series of patients. No major complications occurred; the incidence of minor sequelae was lower than the incidence reported by other studies on pericardiocentesis without continuous visualization. Our technique appears to be safe and easy to perform even in the presence of minimal amounts of pericardial fluid.
1993年至2000年期间，我们冠心病监护病房对48例患者进行了53次心包穿刺术。在最靠近探测探头且检测到最大量液体的部位进行经皮穿刺（43例为前胸穿刺，10例为剑突下穿刺）。将由带有两个固定角度的支架支撑的穿刺针架安装在探头上。在持续可视化的情况下，将穿刺针穿过组织进入心包腔。53例中有52例手术成功。在1例诊断性心包穿刺术中，由于心包积液量极少，无法进入心包腔。在1例经导管消融房室结后发生急性心脏压塞的病例中，心包穿刺导致心包 - 胸膜分流，心包液随之引流至胸腔，症状得以缓解。有1例出现短暂的Ⅲ度房室传导阻滞。所有病例均无需紧急手术引流。在这组患者中，从未发生过心脏壁穿刺。未发生重大并发症；轻微后遗症的发生率低于其他未进行持续可视化的心包穿刺研究报告的发生率。即使在心包积液量极少时，我们的技术似乎也安全且易于实施。
