Pericardiocentesis is a procedure that drains fluid from the tissue around the heart called the pericardium. For patients with pericardial mesothelioma, the procedure relieves the uncomfortable symptoms of pericardial effusion, the buildup of fluid. This is a palliative procedure that treats symptoms but not cancer itself.
What Is a Pericardiocentesis?
Pericardiocentesis is a minimally invasive procedure that drains fluid from around the heart. Doctors insert a needle into the pericardial space and use a catheter to drain the fluid.
Who Needs a Pericardiocentesis?
Fluid around the heart can be caused by many different conditions. It is uncomfortable and causes symptoms that include shortness of breath and chest pain. In some instances, pericardial effusion is life-threatening. Conditions that cause pericardial effusion include:
- Infection
- Cancer, including pericardial cancer
- Heart attack
- Immune system conditions
- Certain medications
- Radiation exposure
- Kidney failure
- Injuries
Cardiac tamponade, excessive pressure on the heart, can result from pericardial effusion. It is treated as an emergency and can be life-threatening if the fluid isn’t drained quickly.
Pericardiocentesis for Diagnosis
Pericardiocentesis can also be a valuable diagnostic tool. A pathologist can examine fluid drawn from the pericardium to find the underlying cause of the effusion.[2]
Examining the fluid from the pericardium may help a doctor diagnose congestive heart failure, inflammation or infection in the pericardium, kidney failure, trauma or damage to the heart, and other causes of effusion.
Cancer may also be diagnosed, but pericardial mesothelioma cannot be confirmed with this test. Cancer cells may not be present in the fluid, but if the test has ruled out other potential causes, a biopsy may be done to remove a section of the pericardium. A pathologist examines this to diagnose cancer.
About Pericardial Mesothelioma
Pericardial mesothelioma is a cancer of the pericardium, the double layer of tissue surrounding the heart. Cancer of the heart lining is extremely rare, and most knowledge about it comes from case studies.
Symptoms of Pericardial Mesothelioma
Pericardial mesothelioma symptoms include chest pains, difficulty breathing, shortness of breath when lying down, and heart palpitations.
Many of the symptoms result from pericardial effusion, a common complication of this cancer. Fluid accumulates between the two layers of the pericardium surrounding the heart.[1]
Symptoms of pericardial effusion include:
- A feeling of fullness in the chest
- Shortness of breath
- Difficulty breathing when lying down
- Chest pain, especially on the left side near the heart
What Is Pericardial Cancer Life Expectancy?
It’s difficult to get statistics on pericardial mesothelioma because it is so rare. Like other types of mesothelioma, it is aggressive and usually terminal.
For some patients, the complications of pericardial mesothelioma are life-threatening. For instance, pericardial effusion is uncomfortable, but it can also impair heart function. If left untreated, it can cause heart failure and, ultimately, death.
Pericardial cancer can also lead to heart failure. This is a common cause of death in patients with pericardial mesothelioma.
What Happens During Pericardiocentesis?
Pericardiocentesis is the most common treatment for pericardial effusion.[2] Your doctor will explain how to prepare for the procedure, what will happen, and what recovery will be like.
Where Is Pericardiocentesis Performed?
The procedure is typically done in a hospital setting. The usual location for the procedure is a cardiac catheterization lab. This is not a procedure performed in a doctor’s office.
The Procedure
- To drain the fluid from the pericardium, a thin needle is inserted through the skin and between the layers of tissue.
- A syringe then withdraws the fluid.
- The patient may need to have intravenous fluids administered during the procedure to provide fluids and medications to reverse a drop in blood pressure or a slowed heartbeat.
- A general anesthetic is not necessary for pericardiocentesis; the patient only receives an injection of local anesthesia to numb the area where the needle is inserted.
- The doctor performing the procedure may use ultrasound or other imaging to guide the needle.
How Long Does a Pericardiocentesis Take?
Pericardiocentesis is usually not a major surgery. It should take just 20 minutes to one hour to complete. Sometimes, the doctor needs to leave the catheter in place to continue draining fluid for a day or two.
Recovery from Pericardiocentesis
Pericardiocentesis is relatively noninvasive. Because the procedure does not require general anesthesia, recovery time is typically short.
Patients may experience some pain from the procedure, which can be treated with medication. In addition, complications may occur, although these are uncommon. Typically, the patient is monitored for a few hours to ensure there are no complications.
Once you return home, you might need some pain medications to manage the side effects of the procedure. Your surgeon will explain any limitations and how long you should rest. You will likely need at least a week to rest and recover.
What Are the Potential Risks and Complications of Pericardiocentesis?
Pericardiocentesis is fairly simple and low-risk. This is especially true if the doctor uses an ultrasound or other image to guide the needle and withdraw fluid. Without the guiding image, the risk of complications increases.
Potential complications of pericardiocentesis include:[3]
- A puncture in the lung resulting in collapse
- Excessive bleeding
- Infection of the pericardium
- Heart arrhythmia
- Air in the pericardium
- A puncture in the heart or a blood vessel
The Benefits of Pericardiocentesis for Mesothelioma Patients
Undergoing a pericardiocentesis has several benefits for cancer patients, and risks are minimal. The main benefit is the relief of symptoms caused by pleural effusion.
The procedure also reduces the risk of complications like heart failure resulting from fluid around the heart. Symptoms caused by effusion make life difficult. Relieving these symptoms can provide patients with a better quality of life.[4]
Pericardial effusion is treated with pericardiocentesis, yet this may not be a permanent fix. Fluid is likely to re-enter the pericardium, causing symptoms to return. If a patient is hospitalized, a catheter may remain in place for continuous drainage.
For other patients, recurrence may mean repeated pericardiocentesis procedures. If you are undergoing this procedure, get as much information as you need to feel comfortable with it.
