Anatomic Approach and Outcomes in Children Undergoing Percutaneous Pericardiocentesis

Pediatr Cardiol. 2021 Apr;42(4):918-925. doi: 10.1007/s00246-021-02563-8. Epub 2021 Feb 16.


Pericardiocentesis is traditionally performed using a subxiphoid approach. Hepatomegaly or loculated and noncircumferential effusions warrant nonstandard approaches to drain effusions; echocardiographic guidance has made these less traditional, non-subxiphoid approaches feasible. The study is aimed at comparing clinical outcomes of the subxiphoid and non-subxiphoid approaches to percutaneous pericardiocentesis in a pediatric population. This is a retrospective chart review of all children undergoing percutaneous pericardiocentesis from August 2008 to December 2019 at a single-center. A total of 104 patients underwent echocardiography-guided pericardiocentesis during the timeframe. Additionally, fluoroscopy was also used in 80 patients. Hematopoietic stem cell transplantation was the most common underlying diagnosis (n = 53, 50.9%). A non-subxiphoid approach was used in 58.6% (n = 61) of patients. The fifth and sixth intercostal spaces were the most commonly used (n = 17 each). The non-subxiphoid group tended to be older (95.9 vs. 21.7 months, p = 0.006) and weighed more (23.6 vs. 11.2 kgs, p = 0.013) as compared to the subxiphoid group. Non-subxiphoid approach was associated with shorter procedure times (21 vs. 37 min, p = 0.005). No major complications were seen. Five minor complications occurred and were equally distributed in the two groups. Complications were more likely in younger patients (p = 0.047). The technique and anatomic approach to pericardiocentesis, and the location or size of effusion did not influence the risk of complications. Echocardiography-guided percutaneous pericardiocentesis in children was associated with low complication rates in this single-center pediatric experience. The use of a non-traditional, non-subxiphoid approach was associated with shorter procedure times and did not significantly affect complication rates.

Keywords: Non-subxiphoid approach; Pericardial effusion; Pericardiocentesis.

MeSH terms

  • Child
  • Child, Preschool
  • Drainage / methods
  • Echocardiography / methods
  • Female
  • Fluoroscopy / methods
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Infant
  • Male
  • Pericardial Effusion / surgery*
  • Pericardiocentesis / methods*
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Treatment Outcome