Incidence and Management of Hemopericardium: Impact of Changing Trends in Invasive Cardiology

Annop Lekhakul, Eric R. Fenstad, Chalailak Assawakawintip, Sorin V. Pislaru, Assefa M. Ayalew, Joseph F. Maalouf, Vuyisile T Nkomo, Jeremy Thaden, Jae Kuen Oh, Larry J. Sinak, Garvan M Kane

Research output: Contribution to journalArticle

Abstract

Objective: As invasive cardiovascular care has become increasingly complex, cardiac perforation leading to hemopericardium is a progressively prevalent complication. We sought to assess the frequency, etiology, and outcomes of hemorrhagic pericardial effusions managed through a nonsurgical echo-guided percutaneous strategy. Patients and Methods: Over a 10-year period (January 1, 2007, to December 31, 2016), 1097 unique patients required pericardiocentesis for clinically important pericardial effusions. Of these 411 had drainage of hemorrhagic effusions (defined as a pericardial hemoglobin level >50% of serum hemoglobin or frank blood in the setting of cardiac perforation). Clinical characteristics, echocardiographic data, details of the procedure, and outcomes were determined. Results: Median patient age was 67 years (interquartile range, 56-76 years), and 60% were men. The procedure was emergent in 83% and elective in 17%. The site of pericardiocentesis was determined by echo-guidance in all: 68% from the left para-apical region, 18% from the left or right parasternal areas, and 14% were subxyphoid. Half (n=215 [52%]) occurred after cardiac perforation with percutaneous interventional procedure (ablation, n=94; device lead implantation, n=65; percutaneous coronary intervention, n=22; other, n=34), whereas 30% followed cardiac or thoracic surgery. Pericardial fluid volume drained was 546±440 mL. In 94% of cases, echo-guided pericardiocentesis was the only treatment of the effusion needed, whereas definitive surgery was required in 25 (6%) cases for persistent bleeding or acute management of the underlying etiology. There was no procedural mortality. Late mortality was better for hemorrhagic effusions compared with a contemporary cohort with nonhemorrhagic effusions. Conclusion: Echocardiographic guidance allows rapid successful pericardiocentesis in the setting of hemopericardium related to microperforation with interventional procedures, malignancy, or pericarditis, with most not requiring surgical intervention. Surgery should remain the first-line approach for aortic dissection or myocardial rupture.

Original languageEnglish (US)
Pages (from-to)1086-1095
Number of pages10
JournalMayo Clinic Proceedings
Volume93
Issue number8
DOIs
StatePublished - Aug 1 2018

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Pericardial Effusion
Pericardiocentesis
Cardiology
Incidence
Thoracic Surgery
Hemoglobins
Pericarditis
Mortality
Percutaneous Coronary Intervention
Dissection
Rupture
Drainage
Hemorrhage
Equipment and Supplies
Serum
Neoplasms

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Lekhakul, A., Fenstad, E. R., Assawakawintip, C., Pislaru, S. V., Ayalew, A. M., Maalouf, J. F., ... Kane, G. M. (2018). Incidence and Management of Hemopericardium: Impact of Changing Trends in Invasive Cardiology. Mayo Clinic Proceedings, 93(8), 1086-1095. https://doi.org/10.1016/j.mayocp.2018.01.023

Incidence and Management of Hemopericardium : Impact of Changing Trends in Invasive Cardiology. / Lekhakul, Annop; Fenstad, Eric R.; Assawakawintip, Chalailak; Pislaru, Sorin V.; Ayalew, Assefa M.; Maalouf, Joseph F.; Nkomo, Vuyisile T; Thaden, Jeremy; Oh, Jae Kuen; Sinak, Larry J.; Kane, Garvan M.

In: Mayo Clinic Proceedings, Vol. 93, No. 8, 01.08.2018, p. 1086-1095.

Research output: Contribution to journalArticle

Lekhakul, A, Fenstad, ER, Assawakawintip, C, Pislaru, SV, Ayalew, AM, Maalouf, JF, Nkomo, VT, Thaden, J, Oh, JK, Sinak, LJ & Kane, GM 2018, 'Incidence and Management of Hemopericardium: Impact of Changing Trends in Invasive Cardiology', Mayo Clinic Proceedings, vol. 93, no. 8, pp. 1086-1095. https://doi.org/10.1016/j.mayocp.2018.01.023
Lekhakul A, Fenstad ER, Assawakawintip C, Pislaru SV, Ayalew AM, Maalouf JF et al. Incidence and Management of Hemopericardium: Impact of Changing Trends in Invasive Cardiology. Mayo Clinic Proceedings. 2018 Aug 1;93(8):1086-1095. https://doi.org/10.1016/j.mayocp.2018.01.023
Lekhakul, Annop ; Fenstad, Eric R. ; Assawakawintip, Chalailak ; Pislaru, Sorin V. ; Ayalew, Assefa M. ; Maalouf, Joseph F. ; Nkomo, Vuyisile T ; Thaden, Jeremy ; Oh, Jae Kuen ; Sinak, Larry J. ; Kane, Garvan M. / Incidence and Management of Hemopericardium : Impact of Changing Trends in Invasive Cardiology. In: Mayo Clinic Proceedings. 2018 ; Vol. 93, No. 8. pp. 1086-1095.
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T1 - Incidence and Management of Hemopericardium

T2 - Impact of Changing Trends in Invasive Cardiology

AU - Lekhakul, Annop

AU - Fenstad, Eric R.

AU - Assawakawintip, Chalailak

AU - Pislaru, Sorin V.

AU - Ayalew, Assefa M.

AU - Maalouf, Joseph F.

AU - Nkomo, Vuyisile T

AU - Thaden, Jeremy

AU - Oh, Jae Kuen

AU - Sinak, Larry J.

AU - Kane, Garvan M

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N2 - Objective: As invasive cardiovascular care has become increasingly complex, cardiac perforation leading to hemopericardium is a progressively prevalent complication. We sought to assess the frequency, etiology, and outcomes of hemorrhagic pericardial effusions managed through a nonsurgical echo-guided percutaneous strategy. Patients and Methods: Over a 10-year period (January 1, 2007, to December 31, 2016), 1097 unique patients required pericardiocentesis for clinically important pericardial effusions. Of these 411 had drainage of hemorrhagic effusions (defined as a pericardial hemoglobin level >50% of serum hemoglobin or frank blood in the setting of cardiac perforation). Clinical characteristics, echocardiographic data, details of the procedure, and outcomes were determined. Results: Median patient age was 67 years (interquartile range, 56-76 years), and 60% were men. The procedure was emergent in 83% and elective in 17%. The site of pericardiocentesis was determined by echo-guidance in all: 68% from the left para-apical region, 18% from the left or right parasternal areas, and 14% were subxyphoid. Half (n=215 [52%]) occurred after cardiac perforation with percutaneous interventional procedure (ablation, n=94; device lead implantation, n=65; percutaneous coronary intervention, n=22; other, n=34), whereas 30% followed cardiac or thoracic surgery. Pericardial fluid volume drained was 546±440 mL. In 94% of cases, echo-guided pericardiocentesis was the only treatment of the effusion needed, whereas definitive surgery was required in 25 (6%) cases for persistent bleeding or acute management of the underlying etiology. There was no procedural mortality. Late mortality was better for hemorrhagic effusions compared with a contemporary cohort with nonhemorrhagic effusions. Conclusion: Echocardiographic guidance allows rapid successful pericardiocentesis in the setting of hemopericardium related to microperforation with interventional procedures, malignancy, or pericarditis, with most not requiring surgical intervention. Surgery should remain the first-line approach for aortic dissection or myocardial rupture.

AB - Objective: As invasive cardiovascular care has become increasingly complex, cardiac perforation leading to hemopericardium is a progressively prevalent complication. We sought to assess the frequency, etiology, and outcomes of hemorrhagic pericardial effusions managed through a nonsurgical echo-guided percutaneous strategy. Patients and Methods: Over a 10-year period (January 1, 2007, to December 31, 2016), 1097 unique patients required pericardiocentesis for clinically important pericardial effusions. Of these 411 had drainage of hemorrhagic effusions (defined as a pericardial hemoglobin level >50% of serum hemoglobin or frank blood in the setting of cardiac perforation). Clinical characteristics, echocardiographic data, details of the procedure, and outcomes were determined. Results: Median patient age was 67 years (interquartile range, 56-76 years), and 60% were men. The procedure was emergent in 83% and elective in 17%. The site of pericardiocentesis was determined by echo-guidance in all: 68% from the left para-apical region, 18% from the left or right parasternal areas, and 14% were subxyphoid. Half (n=215 [52%]) occurred after cardiac perforation with percutaneous interventional procedure (ablation, n=94; device lead implantation, n=65; percutaneous coronary intervention, n=22; other, n=34), whereas 30% followed cardiac or thoracic surgery. Pericardial fluid volume drained was 546±440 mL. In 94% of cases, echo-guided pericardiocentesis was the only treatment of the effusion needed, whereas definitive surgery was required in 25 (6%) cases for persistent bleeding or acute management of the underlying etiology. There was no procedural mortality. Late mortality was better for hemorrhagic effusions compared with a contemporary cohort with nonhemorrhagic effusions. Conclusion: Echocardiographic guidance allows rapid successful pericardiocentesis in the setting of hemopericardium related to microperforation with interventional procedures, malignancy, or pericarditis, with most not requiring surgical intervention. Surgery should remain the first-line approach for aortic dissection or myocardial rupture.

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