We report the successful outcome of ultrasound-guided pericardiocentesis in a 14-week fetus presenting with a right ventricular diverticulum and large pericardial effusion. Congenital ventricular diverticulum is usually isolated but has a variable clinical course in fetal life. Two women were referred at 14 weeks because fetal ultrasound revealed a large pericardial effusion compressing the lungs. Both fetuses showed 2- to 3-mm blood-filled cyst-like structures at the right ventricular apex (Figure 1, A and B). Abdominal situs and cardiac connections were normal, there was no sign of cardiovascular compromise, no extracardiac abnormalities were present, and infection screen and karyotype were normal in both fetuses. The parents of one fetus opted for termination, and ultrasound findings were confirmed at postmortem: a thin-walled fibrous sac communicating with the right ventricular apex via a pinhole aperture (Figure 1C). The second fetus underwent pericardiocentesis. Guided by ultrasound, a 20-gauge needle was inserted percutaneously into the pericardial effusion and 2 mL of straw-colored fluid was aspirated. The fetal lungs then clearly expanded (Figures 2, A and B). Serial echocardiograms until birth showed no effusion, a collapsed diverticulum, and no cardiovascular compromise. Pericardiocentesis was associated with uncomplicated survival to term and an uneventful postnatal course. Postnatal echocardiography (Figure 2C) confirmed the tiny diverticulum originating from the right ventricular apex with no hemodynamic disturbance. No further treatment is planned. Pericardiocentesis is technically challenging in early gestation, but allowed reexpansion of the compressed lungs, normal pulmonary development, and reduction in systemic venous pressures, avoiding potential hydrops and fetal demise.
Figure 1. A and B, Transverse plane through fetal chest demonstrates large pericardial effusion compressing lungs and 2- to 3-mm blood-filled cyst-like structure at right ventricular apex (arrow). C, Gross anatomy at postmortem of fetus 1 with thin-walled fibrous sac communicating with right ventricular apex via pinhole aperture (arrow). Marker 10 mm.
Figure 2. A, Fetal pericardiocentesis was performed at 14 weeks’ gestation. With ultrasound guidance, 20-gauge needle inserted percutaneously into pericardial effusion and 2 mL straw-colored fluid aspirated. B, Fetal lungs expanded; serial scans show collapsed right ventricular aneurysm (arrow). C, Postnatal echocardiography confirmed tiny diverticulum originating from right ventricular apex (arrow) with no hemodynamic disturbance. Marker 10 mm.
Acknowledgments
Disclosure
Dr Pasquini is supported by echo uk (www.echocharity.org.uk).
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- Pericardiocentesis at 14 Weeks
