An excessive buildup of fluid in the fluid-filled sac that surrounds the heart, known as the pericardium, can be treated with a procedure called pericardiocentesis, also known as a pericardial tap. Patients with pericardial mesothelioma may opt for pericardiocentesis with the intent of alleviating the symptoms of their diagnosis as a form of palliative care.¹

When excess fluid begins to form and linger in the lining of the heart, patients develop a condition known as pericardial effusion. When this fluid gradually forms over time, a patient may have no symptoms, or may experience symptoms such as chest tightness, pressure, or pain, or shortness of breath. If left untreated, this condition can have severe medical consequences, as an extensive pericardial effusion can interfere with normal heart function and even result in cardiac tamponade, a life-threatening compression of the heart that can deteriorate into cardiogenic shock, cardiovascular collapse, cardiac arrest, multiorgan failure, and ultimately, death. By removing this fluid, pericardiocentesis can reduce these symptoms significantly and prevent life-threatening complications .²

Thanks to medical science and technology advancements, pericardiocentesis has become significantly safer and more effective. The primary advancement that made the procedure safer was the advent of the ultrasound. This scanning technique now guides pericardiocentesis, greatly reducing risks. Pericardiocentesis is a relatively non-invasive procedure compared to open surgical drainage for pericardial effusion.

Benefits for Pericardial Mesothelioma

Pericardiocentesis is usually performed by cardiothoracic surgeons, interventional cardiologists, and cardiologists trained in invasive techniques. It is chosen for patients with evidence of pericardial effusion. The goals of the procedure are to alleviate symptoms of the condition such as chest pain and shortness of breath, and improve the overall quality of the patient’s life. Pericardial effusion can often occur as a result of pericardial mesothelioma, and pleural mesothelioma and peritoneal mesothelioma that have spread to the pericardium. A successful pericardiocentesis does not provide a cure for the underlying disease, but is effective at treating symptoms and can prevent further effusions from forming in the pericardium, as well as life-threatening complications.

Pericardiocentesis: What to Expect

Pericardiocentesis is typically performed in an operating room, a cardiac catheterization lab, or at the patient’s bedside, depending on the facilities available. Patients abstain from eating and drinking for six hours or more before surgery and are placed on an IV to ensure any needed medications or fluids can be administered if required during the procedure.

The procedure is performed under local anesthesia, administered by an anesthesiologist, just below the patient’s sternum. Once the area is sufficiently sterilized and numbed, a long, thin needle is used to penetrate the chest, enter the pericardial sac, and remove the fluid. This needle is guided by using an echocardiogram, an ultrasound that focuses on the cardiac region, to ensure the procedure is conducted safely and efficiently. Once the needle has successfully entered the pericardial cavity of the pericardium, it is replaced with a catheter tube to allow the fluid from the effusion to drain. This drainage can occur in several hours or days. Patients may experience tightness or pressure in the chest when the needle is initially inserted, as well as increased discomfort and pain as the effusion drains. Doctors will often administer pain medication during the procedure and after the anesthesia has worn off.

Recovery from Pericardiocentesis

Recovery from a successful pericardiocentesis is relatively quick, generally only requiring hospitalization for one or more days, although doctors will advise patients to avoid unnecessary physical exercise or strenuous activity until they are satisfied with the patient’s recuperation. To fully evaluate the removal of the fluid, doctors may choose to order an additional echocardiogram, and an X-ray may be performed to ensure that the needle hasn’t damaged or punctured the patient’s lungs. During the recovery period, a patient’s vital signs will be closely monitored to ensure that breathing, oxygen levels, blood pressure, and heart rate remain at normal levels. Patients will be advised to contact their medical team immediately if they experience severe chest pain or increased and uncomfortable drainage from the insertion point of the needle.

Risks and Potential Complications of Pericardiocentesis

All procedures have risks, and there is the potential for complications to emerge either during or after pericardiocentesis. These complications may include

• Excessive bleeding
• Puncture of the liver, heart, or surrounding blood vessels
• Infection in or around the insertion point or procedure site
• Arrhythmia: abnormal heart rhythm
• Pneumothorax: air buildup within the chest cavity
• Air embolism: blood vessel blockage caused by one or more bubbles of air
• Pericardial decompression syndrome: worsening heart function leading to heart failure and pulmonary edema (fluid in the lungs) as a result of the procedure

The likelihood of these complications is relatively rare, given the simpler nature of this procedure. A patient’s propensity to experience complications can vary greatly depending on conditions such as health status, age, and the severity of the pericardial effusion. As these effusions can develop again over time, repeat pericardiocentesis may be required to remove fluid buildup.

Recurrent Pericardial Effusion

Recurring pericardial effusions may require regular pericardiocentesis to manage and remove fluid buildup. These effusions can be detected using echocardiogram or chest x-ray. A CT scan can be used to detect tumors associated with pericardial mesothelioma and the resulting pericardial effusion.

Doctors almost always conduct an analysis of the extracted fluid following a pericardiocentesis. This analysis, known as effusion cytology, allows for further diagnosis of the condition and scheduling further treatment.

Effusion cytology is less effective in detecting pericardial mesothelioma. For surgeons and oncologists to make an accurate diagnosis of primary pericardial mesothelioma, a biopsy of tumor mass needs to be performed. This biopsy can be attained via pericardiectomy, which can also be used to drain pericardial effusions and prevent them from building up again in the future.³