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Journal of Thoracic Oncology:
doi: 10.1097/JTO.0b013e318230860e
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Percutaneous Balloon Pericardiotomy for Recurrent Malignant Pericardial Effusion

Jones, Daniel A. MBBS, BSc*†; Jain, Ajay K. MBBS, MRCP, MD*†

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*NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital; †Department of Cardiology, Barts and the London NHS Trust, London, United Kingdom.

Disclosure: The authors declare no conflicts of interest.

Address for correspondence: Daniel A. Jones, MBBS, BSc, Department of Cardiology, London Chest Hospital, Bonner Road, Bethnal Green, London E2 9JX, United Kingdom. E-mail: danieljones@doctors.org.uk

An 82-year-old woman with stage 3 non-small cell lung cancer presented with a large pericardial effusion demonstrated by transthoracic echocardiography (TTE) (Figure 1, white arrow) (Supplemental Digital Content 1, http://links.lww.com/JTO/A157). She had a history of previous pericardial effusion treated with pericardiocentesis. She was evaluated and deemed high risk for definitive surgical treatment. Therefore, she underwent percutaneous balloon pericardiotomy, performed from a subxiphisternal approach under aseptic technique with fluoroscopic and echocardiographic guidance (Figures 2A–D) (Supplemental Digital Content 2–4, http://links.lww.com/JTO/A158, http://links.lww.com/JTO/A160, and http://links.lww.com/JTO/A161). Six hundred milliliters of serous fluid was aspirated, resulting in immediate symptomatic improvement. Three months later, TTE revealed a small stable effusion with no diastolic right atrium/right ventricle/collapse.

Figure 1
Figure 1
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Figure 2
Figure 2
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Malignant disease is a common cause of pericardial effusion with incidences ranging from 1 to 20% in all cancer patients.1,2 Management is challenging with recurrence rates of 13 to 50%3 after pericardiocentesis and patients often unsuitable for surgical intervention. Percutaneous balloon pericardiotomy is a simple and safe minimally invasive alternative to drain pericardial effusions.

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REFERENCES

1.Kline I. Cardiac lymphatic involvement by metastatic tumour. Cancer 1972;29:799–808.

2.Lockwood WB, Broghamer WL Jr. The changing prevalence of secondary cardiac neoplasms as related to cardiac therapy. Cancer 1980;45:2659–2662.

3.Galli M, Politi A, Pedretti F, et al. Percutaneous balloon pericardiotomy for malignant pericardial tamponade. Chest 1995;108:1499–1501.

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© 2011International Association for the Study of Lung Cancer

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