CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 4, May 2013
e12
AFRICA
Recently, PBP has been applied as a useful and less-invasive
therapy for recurrent, large pericardial effusions and is an
alternative option to surgical pericardiotomy.
1,5
Ziskind
et
al
.
reported the effectiveness of creating a pericardial window with
PBP and described a success rate of 92%.
1
Then Chow and Chow
described the Inoue balloon catheter for this procedure.
5
Several
authors have reported on the usefulness of this procedure with
the Inoue balloon catheter but there have been no such case
reports from Turkey.
Our cases were end-stage lung cancer patients who presented
with recurrent cardiac tamponade. We performed PBP with the
Inoue balloon and this technique prevented collection of fluid
and recurrent pericardial tamponade. We preferred the Inoue
balloon rather than the double-balloon technique, which differ
from each other in several important aspects.
The Inoue technique has been reported to be easier to perform
and needs shorter total procedure and fluoroscopic times.
The dilating shape achieved in the Inoue balloon is circular,
and different from the elliptical dilating shape achieved in the
double balloon.
6,7
These findings are consisted with our previous
experiences. Also the Inoue balloon with its bi-lobular structure,
self-centering mechanism and high radial strength, which is
required for tearing the pericardium, are advantages of the Inoue
balloon over other type of balloon.
Previous reports have described that the balloon should be
inflated at least twice.
8-10
For this procedure, we performed
three inflations to ensure an adequate tear in the pericardium.
The mechanism of pericardial window creation was studied by
Falciolas
et
al
.
9
They reported the balloon inflation had resulted
in a localised tearing in the parietal pericardium, creating a
communication between the pericardial and pleural or rarely the
abdominal cavities, in patients treated with PBP.
We suggest that the indication for balloon pericardiotomy
should be restricted to selected cases of pericardial effusion
with recurrent cardiac tamponade despite drainage by
pericardiocentesis, or for cases not allowing further drainage
with a catheter at the time of recurrence. These cases demonstrate
the efficacy of PBP with the Inoue balloon in patients where a
pericardial window may be needed. However, the Inoue balloon
is more expensive than other balloon systems, so we recommend
using it only in selected cases.
Conclusions
We found PBP with the Inoue balloon to be a safe, simple
procedure with a high rate of success and low incidence of
complications and recurrences. PBP with the Inoue balloon
appears to be an effective method for the palliation of patients
with large, malignant pericardial effusions. In spite of its
relatively high cost, this technique could be used in our country
for selected cases of critically ill patients, instead of the surgical
subxiphoid pericardial window.
References
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J
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