A novel technique for accessing the pericardial space.

BACKGROUND

Pericardial procedures are potentially dangerous in patients with minimal anterior pericardial effusion and cases with pericardium adhesion.

OBJECTIVE

To enhance safety, we used an innovative wire puncture technique for pericardiocentesis.

METHODS

The hard end of the percutaneous transluminal coronary angioplasty guidewire was used to puncture the parietal pericardium. To improve the puncture ability, a flat-tipped metal tube was used to support the guidewire; furthermore, a microcatheter was used to exchange the soft end of the guidewire. Before the clinical trial, the novel technique was tested in 10 pigs to evaluate its feasibility and safety.

RESULTS

The novel method achieved a 98.15% success rate in all 10 pigs and 54 patients with challenging pericardiocentesis, including minimal anterior effusion (5.50 ± 2.28 mm) and dry pericardiocentesis with no significant complications. The wire puncture technique also proved effective for acute iatrogenic pericardial effusion, even in pericardial adhesions.

CONCLUSION

The innovative wire puncture technique is safe and feasible for challenging pericardiocentesis, even in cases with pericardial adhesions.