Pericardiocentesis

Pericardiocentesis (pericardial tapping)

The fluid that appears and builds up in the pericardial cavity can cause a life-threatening condition when the heart is "strangled" (the heart in the pericardium suffers from abnormal fluid, initially in the form of a diastolic (pulsatile) heart, and later in the form of a systolic heartbeat. This condition is cardiac tamponade.

The appearance and build-up of fluid - usually blood or bloody content - may warrant a pericardial drain, depending on its extent. The accumulation of inflammatory octane fluid in the pericardium is rare.

OKOK

It may be caused by bloody contents in the pericardial cavity:

  • a tumour at the base of the heart or a tumour involving the pericardial region (haemangiosarcoma, chemodectoma, mesothelioma)
  • blood clotting disorder
  • atrial fissure
  • vascular rupture of unknown cause (idiopathic)

TUNETTE

Poor general condition, weakness, loss of appetite, lethargy.

In case of complaints persisting for several days due to increase in hasterime, appearance of abdominal fluid.

PHYSICAL EXAMINATION

Physical examination may reveal distant heart sounds when listening to the heart.

An enlarged cardiac congestion is characteristic of chest palpation.

If the problem has been present for a long time, free fluid can be felt in the abdomen.

ADDITIONAL TESTS

A chest X-ray may show evidence of an enlarged heart valve.

A cardiac ultrasound (echocardiography) scan can be used to safely confirm the presence of fluid build-up in the pericardium.

DRAINING THE PERICARDIUM

Once the diagnosis has been made, a coagulation test should be performed if a coagulation disorder is suspected.

If atrial fissure is suspected, the procedure should not be performed.

If necessary, the tap is performed in the right lateral position under ultrasound guidance on the left side of the chest, with the insertion of a needle or cannula, using a suction device, in either the awake or the anaesthetised state, depending on the general condition of the animal.

A cytological examination of the sample of the fluid removed during the procedure - to identify the pathogenic factor - can be recommended (a negative cytological result does not exclude a tumour background, but is pathognomonic in the case of a positive result).

The success of the tapping is confirmed by an ultrasound scan after the procedure (the scan is particularly important to check the area of the heart base for any tumour background that may be detectable by ultrasound; it cannot be excluded for tumours smaller than the detectable size).

RISK ANALYSIS

In the case of a cardiac tamponade, the performance of a pericardiocentesis is a life-saving intervention, and should not be considered, with the exception of atrial tears, if properly equipped and practised.

However, tapping is not a harmless procedure, as the needle or cannula inserted can cause damage to the coronary arteries on the surface of the heart due to breathing movements, which can be fatal in the worst case.

Overall, in the case of a significant spillage, it is recommended to carry out tapping, taking into account the pros and cons analysis.

LOGIN

A follow-up ultrasound scan 1-2 days after treatment is necessary to confirm the presence or extent of any recurrence.

In case of recurrence, the procedure can be repeated or combined with surgery (pericardectomy) if necessary.

COVER

It varies depending on the causal factors:

  • if you have cancer, depending on the type of cancer
  • good in idiopathic cases
  • in case of a blood clotting disorder, depending on the underlying disease
  • for atrial tears, depending on the tamponade of the damaged atrial wall