Irazusta Francisco Javier, Jiménez-Valero Santiago, Gemma Daniele, Meras Pablo, Galeote Guillermo, Sanchez-Recalde Angel, Rial Veronica, Moreno Raul, Lopez-Sendon Jose Luis
Cardiology Department, La Paz University Hospital, Madrid, Spain.
Cardiology Department, La Paz University Hospital, Madrid, Spain.
Cardiovasc Revasc Med. 2017 Jul-Aug;18(5S1):S14-S17. doi: 10.1016/j.carrev.2017.03.029. Epub 2017 Apr 4.
Malignant pericardial effusion has a high recurrence rate after pericardiocentesis. We sought to confirm the efficacy and feasibility of percutaneous balloon pericardiotomy (PBP) as the initial treatment of choice for these effusions.
Retrospective analysis of the clinical, echocardiographic, and follow-up characteristics of a consecutive series of PBP carried out in a single-center in patients with advanced cancer.
Forty PBPs were performed in 35 patients with a mean age of 61.8years (55% females). Thirty-four patients had pathologically confirmed metastatic neoplastic disease (26 patients with tumoral cells in the pericardial liquid), 7 had previously required pericardiocentesis, and in the remaining patients PBP was the first treatment for the effusion. All patients had a severe circumferential effusion (29mm by mean on transthoracic echocardiography [TTE]), and most presented evidence of hemodynamic compromise on TTE. In all cases, the procedure was successful, there were no acute complications, and it was well tolerated at the first attempt. There were no infectious complications during follow-up. One patient developed a pseudoaneurysm in the right ventricle, even though no further treatment was required. Eight patients needed a new pericardial procedure: 3 had elective pericardial window surgeries and 5 had a second PBP. Eighty percent of patients died during follow-up (57days by mean from the PBP) regarding their oncological disease.
PBP is a simple and safe technique that can be effective in the prevention of recurrence in many patients with severe malignant pericardial effusion. The characteristics of this procedure make it particularly useful in this group of patients to avoid more aggressive, poorly tolerated approaches, since they have a very poor prognosis regarding to their oncological disease.
恶性心包积液在心包穿刺术后复发率较高。我们旨在证实经皮球囊心包切开术（PBP）作为这些积液初始治疗选择的有效性和可行性。
对在单中心为晚期癌症患者进行的一系列连续PBP的临床、超声心动图及随访特征进行回顾性分析。
35例患者共进行了40次PBP，平均年龄61.8岁（女性占55%）。34例患者经病理证实有转移性肿瘤疾病（26例心包液中有肿瘤细胞），7例此前曾需要心包穿刺，其余患者PBP是积液的首次治疗方法。所有患者均有严重的环周积液（经胸超声心动图[TTE]平均为29mm），且大多数在TTE上有血流动力学受损的证据。所有病例手术均成功，无急性并发症，首次尝试时耐受性良好。随访期间无感染并发症。1例患者右心室出现假性动脉瘤，不过无需进一步治疗。8例患者需要再次进行心包手术：3例行选择性心包开窗手术，5例行第二次PBP。80%的患者在随访期间因肿瘤疾病死亡（自PBP起平均57天）。
PBP是一种简单且安全的技术，对许多严重恶性心包积液患者预防复发可能有效。该手术的特点使其在这类患者中特别有用，可避免采用更激进、耐受性差的方法，因为他们的肿瘤疾病预后很差。
