Carbon Dioxide Insufflation for Assessment of Pericardial Adhesions and Informed Decision-Making for Percutaneous Epicardial Access in a Patient With Prior Cardiac Surgery.

Carbon dioxide insufflation via intentional coronary sinus perforation allowed real-time assessment of pericardial adhesion distribution before pericardial puncture. Despite localized adhesions, visualization of preserved pericardial space at the intended access site enabled informed procedural planning and safe percutaneous epicardial ablation in a patient with prior cardiac surgery.