Intermittent Echocardiographic Monitoring During Superior Vena Cava Recanalization: A Protocol for Early Recognition and Management of Hemopericardium.

Purpose: Endovascular recanalization and stent reconstruction constitute an effective and safe treatment option for symptomatic thoracic central venous obstruction (TCVO). Rare life-threatening adverse events are possible during or immediately following the procedure, with the most feared one being hemopericardium with cardiac tamponade. A technique to improve efficiency in detection and treatment of cardiac tamponade is described.

Materials and methods: An institutional protocol was established for intraprocedural transthoracic echocardiographic monitoring during the TCVO recanalization procedures. The lower chest and upper abdomen were prepared within the sterile field. A separate stand was set up with unopened supplies needed for pericardial drain placement. Intermittent echocardiographic monitoring was performed throughout the TCVO procedure using a dedicated curvilinear probe prepared on the field. If indicated, an image guided pericardial drain was placed expeditiously.

Results: Four cases of cardiac tamponade were encountered during or immediately post-procedure. All cases demonstrated technically successful and prompt pericardial drain placement with immediate reversal of the tamponade physiology.

Conclusion: Echocardiographic monitoring during TCVO reconstruction by interventional radiologists is a useful technique which may aid in early diagnosis and management of cardiac tamponade.