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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:

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, 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,,, and 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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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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