Galli M, Politi A, Pedretti F, Castiglioni B, Zerboni S
Cardiology Department, S. Anna Hospital, Como, Italy.
Chest. 1995 Dec;108(6):1499-501. doi: 10.1378/chest.108.6.1499.
Recurrent pericardial effusion or tamponade can complicate malignant disease. The medical approach with pharmacologic agents has a high recurrence rate. Balloon pericardiotomy (BP) may provide a less invasive alternative to surgery. We performed BP in ten high-risk patients with malignant pericardial tamponade (MPT). BP was performed with aseptic technique under fluoroscopic and echocardiographic guidance. We used a percutaneous subxiphoid approach. A 20- to 25-mm-wide and 4-cm-long balloon was introduced over a stiff guide wire, positioned across the parietal pericardium, and manually inflated until the waisting disappeared. Echocardiographic study and chest radiograph were taken before, immediately after the procedure, and during follow-up. The procedure was successful and well tolerated in all patients. There were no immediate or late complications. No patients developed recurrence of pericardial effusion at up to 10 months' follow-up. In conclusion, BP can be performed in patients with MPT with high rate of procedural success. It may become the preferred treatment to avoid a more invasive procedure in these critically ill patients.
复发性心包积液或心包填塞可使恶性疾病复杂化。使用药物的医学方法复发率很高。球囊心包切开术（BP）可能为手术提供一种侵入性较小的替代方法。我们对10例高危恶性心包填塞（MPT）患者进行了BP。BP在荧光镜和超声心动图引导下采用无菌技术进行。我们采用经皮剑突下途径。将一个宽20至25毫米、长4厘米的球囊通过一根硬导丝引入，置于脏层心包上，手动充气直至腰部消失。在手术前、手术后立即及随访期间进行超声心动图检查和胸部X线检查。所有患者手术均成功且耐受性良好。无即刻或晚期并发症。在长达10个月的随访中，无患者出现心包积液复发。总之，MPT患者行BP手术成功率高。在这些重症患者中，它可能成为避免更具侵入性手术的首选治疗方法。
