eComment. Minimally invasive techniques for malignant pericardial effusions

We have read with great interest the article by Mirhosseini et al. concerning risk factors affecting the survival rate in patients with symptomatic pericardial effusion undergoing surgical intervention [1]. They conclude that patients with underlying malignant diseases, particularly lung cancer or an invasion of the thorax, detected by computed tomography, have poor survival and are at a greater risk of postoperative death. Therefore, minimally-invasive therapies should be considered as a more acceptable alternative for these high-risk patients. The aim of our brief comment is to highlight the advantages of pericardiocentesis followed by intrapericardial cisplatin administration in patients with cardiac tamponade due to lung cancer. At our centre, we consider pericardiocentesis and subsequent cisplatin administration as the method of choice for preventing recurrence of malignant pericardial effusion. Our results were documented in a 5-year study [2]. In our study, death was attributed to generalized carcinomatosis causing respiratory failure in all patients. No patient died of recurrent cardiac tamponade. The main advantage of this treatment is that cisplatin infusion neither causes pain nor influences the haematological profile, because of the minimal systemic absorption from the pericardium. Intrapericardial fibrosis due to cisplatin infusion proved not to cause constrictive pericarditis even in long-term survivors. Pericardiocentesis followed by intrapericardial administration of cisplatin is safe and effective in preventing the re-accumulation of malignant pericardial effusion in the majority of oncologic patients and should be the gold standard. In case of recurrence or diagnostic dilemmas, the creation of a pleuropericardial window through a mini-thoracotomy or a video-assisted thoracoscopic surgery procedure is the last alternative and is absolutely indicated. Conflict of interest: none declared.