Читать книгу Interventional Cardiology - Группа авторов - Страница 349

This entity has been traditionally treated with emergency pericardiocentesis. Echocardiography is typically used to establish the diagnosis. Although this can be performed under critical conditions with only body landmarks (needle insertion in subxiphoid area with shallow aim towards the left mid‐clavicular line), it is mostly performed with echocardiographic and fluoroscopic guidance. The echocardiographer can image the pericardial effusion from subxiphoid or apical window and identify the easiest projection to allow a straight needle track. Under local anesthesia (sedation can be rarely tolerated in such patients) and with patient positioned with a 20–40 ° upper body incline, the needle can be inserted parallel to the echo‐beam and should then be anticipated to reach the pericardial space at the depth identified by the imager. If a pressure transducer is available and zeroed at a 50 mmHg scale set‐up, it may be utilized to measure the pericardial pressure before and after fluid removal. Hemodynamic response is typically immediate upon removal of the fluid. On the other hand, shock/hypotension due to multi‐factorial cases may be associated with sizeable pericardial effusion and minor echocardiographic signs of tamponade; in such cases, the rather low and phasic pericardial pressure waveform will be indicative (to rule out a pericardial tamponade as the primary cause of hemodynamic collapse). A surgical pericardial window may be undertaken in mainly posterior effusions or in complicated cases for pericardiocentesis (or in those that a pericardial biopsy is of major diagnostic importance) [41].