Balloon Pericardiotomy: A Comprehensive Review and Case Series

Pericardial effusions can occur owing to a variety of reasons such as trauma, infection, autoimmune disease, and malignancy. Cardiac tamponade depends on the rate of fluid accumulation and not solely on the volume of the pericardial effusion. Rapid accumulation of pericardial fluid can lead to impaired cardiac filling and output with hemodynamic consequences, requiring urgent or emergent intervention. Despite initial intervention on patients with cardiac tamponade, recurrence of pericardial effusions has been estimated at approximately 20%, with a mean interval to recurrence of approximately 1 month. Both interventional and surgical techniques have been developed to relieve excess pericardial fluid including pericardiocentesis, surgical pericardiotomy, and percutaneous balloon pericardiotomy (PBP) with the latter 2 generally reserved for recurrent effusions. Rarely, surgical pericardiectomy is pursued. While safety and outcomes data are readily available for both pericardiocentesis and surgical pericardiotomies, PBPs are performed less frequently and at the few medical centers with the necessary expertise. In this case series, we present our center’s experience with PBP in the management of recurrent pericardial effusions in 4 different patients. We highlight their comorbidities and corresponding high surgical risk as well as review the technical considerations and outcomes of each patient. Aside from a small pneumothorax managed conservatively, there were no adverse side effects encountered. Balloon pericardiotomy is a safe and effective modality for pericardial effusion drainage in high-risk patients, which can improve patient comfort and hemodynamics.