Pericardiocentesis From Back Under Echographic Guidance
An Approach for Posterior Pericardial Effusions
A 72-year-old man with degenerative aortic stenosis, coronary artery disease, hypertension, and chronic renal insufficiency presented with progressively worsening dyspnea, tachycardia, hypotension, and diuresis contraction 7 days after undergoing successful aortic valve replacement (stentless valve, 27 mm) and coronary artery revascularization. On presentation to the intensive care unit, the patient was found to have a notably bilateral pleural effusion. The blood sample revealed normal values of both troponin and creatine kinase. ECG displayed sinus rhythm with diffuse aspecific repolarization abnormalities. A transthoracic echocardiogram demonstrated normal left ventricular ejection fraction, concentric hypertrophy of the left ventricle, no valvular dysfunction, and preserved right ventricular function. A posterior-lateral echographic view showed a large left pleural effusion, a significant posterior pericardial effusion, and a prominent pericardial layer demarcating the 2 fluid-filled sacs (Figure and Movie I in the online-only Data Supplement).
Pleuropericardiocentesis was urgently performed. The landmark for needle insertion corresponded to the area …