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Iatrogenic Pericardial-pleural Fistula: A Useful Complication Of Emergent Pericardiocentesis.
Behnam Shakerian;
Shahrekord University of Medical Sciences, shahrekord, Iran, Islamic Republic of
BACKGROUND:Iatrogenic pericardial-pleural fistula (PPF) is a rare complication of pericardiocentesis (PC). The actual incidence has not been clear. Gary et al. report a 6% incidence of iatrogenic PPF. Echocardiography is the most sensitive diagnostic test for the diagnosis of this complication.
METHODS:A 68-year-old man with a chief complaint of new-onset severe chest pain was diagnosed with acute inferior myocardial infarction. He was transferred to a catheterization laboratory for primary percutaneous coronary intervention. Coronary angiography showed full occlusion of the mid-portion of the right coronary artery. After stenting followed by balloon pre-dilatation, post-dilatation was done and type 3 coronary perforation was detected. A cover stent was immediately implanted in the rupture area. At the same time, the patient’s general condition worsened suddenly. Immediately he was intubated. Needle aspiration of the pericardial space confirms intrapericardial effusion. Percutaneous pericardiocentesis was performed via a subxiphoid approach. A 7-F puncture kit was employed and a multihole-pigtail catheter was introduced into the pericardial space, but no fluid was aspirated. A further attempt from another site was successful but failed to aspirate any further fluid. Despite the failure of the procedure, there was an immediate improvement in the patient’s hemodynamics, and blood pressure returned to normal in a short period. Same-day Chest-X-Ray and echocardiography revealed a left-sided pleural effusion with complete resolution of the pericardial effusion. He underwent pleural drainage and 1000ml of blood was drained. The patient recovered fully and was discharged on the 6th postoperative day.
RESULTS:Cardiac tamponade is a medical emergency necessitating emergent pericardiocentesis. A serious complication of PC is rare. These complications include ventricular arrhythmia, cardiac perforation, and laceration of the coronary artery. This communication and high intrapericardial pressure caused by rapid PE accumulation promoted a flow gradient for the effusion from the pericardial sac to the pleural cavity in a rapid fashion. Echocardiography during pericardiocentesis is crucial. For patients with PPF.
CONCLUSIONS: We think that rapid drainage of pericardial fluid into the pleural space is an acceptable result confronting the life-threatening feature of tamponade due to pericardial effusion.
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