Pericardiocentesis From Back Under Echographic Guidance

A 72-year-old man with degenerative aortic stenosis, coronary artery disease, hypertension, and chronic renal insufficiency presented with progressively worsening dyspnea, tachycardia, hypotension, and diuresis contraction 7 days after undergoing successful aortic valve replacement (stentless valve, 27 mm) and coronary artery revascularization. On presentation to the intensive care unit, the patient was found to have a notably bilateral pleural effusion. The blood sample revealed normal values of both troponin and creatine kinase. ECG displayed sinus rhythm with diffuse aspecific repolarization abnormalities. A transthoracic echocardiogram demonstrated normal left ventricular ejection fraction, concentric hypertrophy of the left ventricle, no valvular dysfunction, and preserved right ventricular function. A posterior-lateral echographic view showed a large left pleural effusion, a significant posterior pericardial effusion, and a prominent pericardial layer demarcating the 2 fluid-filled sacs (Figure and Movie I in the online-only Data Supplement).Figure. Posterior echographic view shows large left pleural effusion and pericardial fluid collection before pericardiocentesis. Moreover, the left ventricular posterior wall and thoracic descending aorta are visualized.Pleuropericardiocentesis was urgently performed. The landmark for needle insertion corresponded to the area …