Objectives: Pericardiocentesis has traditionally utilized the subxiphoid approach originally described by Marfan over 100 years ago. However, the left lateral (LL) approach using echocardiographic guidance offers an equally effective but shorter, more direct and perhaps safer route, especially for those pericardial effusions (PCE) that are loculated and/or posterolaterally located. We report our experience with this approach.
Methods: The records of all pts who underwent pericardiocentesis using the LL approach from 1/07 to 12/08 at Texas Children's Hospital were reviewed. Procedural data included location of entry, depth of needle required to enter the pericardium, amount and type of fluid removed, and complications.
Results: 18pts(20procedures) underwent this approach. Median age was 8.8yr (range:1mo-17.25yr). Presumed etiology was related to blood dycrasias(7), post viral(4), post-op(2), and others(5). Mean effusion was 7.8±4.2mm inferiorly and 18.5±6.7mm posterolaterally. Needle entry was all in the LL(16) or peri-apical region(2). Depth of needle entry ranged 5-20mm. Amount of fluid drained averaged 209±126cc. Serous fluid was noted in all but 3(serosanguious). Pericardial drains were left in place in 3. Minor complications included a small anterior pneumothorax(1) and inadvertent entrance into pleural space(2) without further sequelae. No major complications occurred.
Conclusion: The LL approach for pericardiocentesis is safe & effective when there is a significant posterolateral PCE. Entrance from skin to pericardium is no more than 2cm thereby minimizing errors related to angle and distance of needle penetration. Rare minor complications include pneumothorax and entrance into pleural space. This approach should be considered in the majority of pts with PCE.