CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 4, May 2013
e10
AFRICA
Case Report
Percutaneous balloon pericardiotomy using the
Inoue balloon for patients with recurrent pericardial
tamponade
BARIS KILICASLAN, IBRAHIM SUSAM, HUSEYIN DURSUN, CENK EKMEKCI, MEHMET AYDIN, ONER OZDOGAN
Abstract
Background:
Recurrent pericardial effusion is often caused
by pericardial metastases of extra-cardiac tumours. These
effusions may be moderate to severe, leading to cardiac
tamponade. The treatment is emergency pericardiocentesis
but in spite of the initial success of that treatment, the effu-
sions have high recurrence rates. Here we describe our expe-
rience of percutaneous balloon pericardiotomy (PBP) using
the Inoue balloon for the management of three patients with
malignant pericardial effusions secondary to lung cancer.
Methods:
In our clinic, three patients with recurrent peri-
cardial effusion secondary to lung cancer were treated with
percutaneous pericardiotomy with an Inoue valvuloplasty
balloon catheter through the subxiphoid approach.
Results:
Successful drainage with balloon pericardiotomy
was achieved in all patients without severe complications. In
all cases, only one pericardial site was dilated at least three
times. During the four to six months of follow up, there were
no recurrences of the effusion or tamponade. All patients
were still alive.
Conclusions:
In our experience, PBP with the Inoue balloon
appears to be a simple and safe procedure with a high success
rate. PBP is an effective method for the management of
patients with recurrent, large, malignant pericardial effu-
sions.
Keywords:
recurrent pericardial tamponade, Inoue balloon,
percutaneous balloon pericardiotomy
Submitted 9/12/12, accepted 18/3/13
Cardiovasc
J Afr
2013;
24
: e10–e12
DOI: 10.5830/CVJA-2013-019
The incidence of metastatic malignancies of the myocardium
and pericardium has been reported in between 2 and 21% of
all cancer patients. Pericardial effusions related to malignancies
usually lead to cardiac tamponade, which requires emergency
drainage by pericardiocentesis. However they have high
recurrence rates after this treatment.
1
For the prevention of
recurrences, several surgical and non-surgical approaches have
been developed. Intrapericardial installation of chemotherapeutic
drugs, radiation therapy, surgical creation of a pleuropericardial
window via the lateral approach, or subxiphoid pericardiotomy,
and pericardiectomy have been used.
1-3
In 1991 Palacios
et
al
. first described percutaneous balloon
pericardiotomy (PBP).
4
Then Chow and Chow reported on and
described the Inoue balloon catheter for this procedure.
5
This
technique is less invasive and more comfortable than surgery.
We describe our experience of PBP using the Inoue balloon in
the management of malignant pericardial effusion secondary to
lung cancer.
Case report
We performed PBP with the Inoue balloon in three patients
with lung cancer. The clinical characteristics of the patients
are summarised in Table 1. All cases had severe pericardial
effusion causing clinical and echocardiographic signs of cardiac
tamponade. Pericardiotomy was performed in patients with at
least one recurrence after the previous drainage (Fig. 1). In the
first patient, we had performed PBP with another balloon but
two weeks later, he was admitted our clinic with pericardial
tamponade, so we performed PBP with the Inoue balloon.
Methods
In the catheterisation laboratory, after administration of local
anaesthesia, the pericardium was entered with an 18-gauge
pericardial needle via the standard subxiphoid approach. A
0.025-inch guide wire was advanced into the pericardial space
under fluoroscopy, and the needle was removed. The tract of the
needle was dilated with an 8-F dilator, and an 8-F pericardial
pigtail catheter was inserted.
Tepecik Research and Training Hospital, Izmir, Turkey
BARIS KILICASLAN, MD,
IBRAHİM SUSAM, MD
HUSEYİN DURSUN, MD
CENK EKMEKCİ, MD
MEHMET AYDİN, MD
ONER OZDOGAN, MD
TABLE 1. CLINICAL CHARACTERISTICS OF PATIENTS
Patients
Age
(years)/
gender
Disease
Number of
pericardio-
centeses
before PBP Recurrences
Follow up
(months)
1
50/male Lung cancer
3
No
6
2
65/male Lung cancer
2
No
6
3
63/male Lung cancer
3
No
6
