Acute pericardial disease: Pericardiocentesis and percutaneous pericardiotomy

Pericardial diseases can present with a myriad of clinical manifestations including pericarditis, pericardial effusion, and tamponade. While pericarditis is often a self-limiting disorder that is responsive to nonsteroidal antiinflammatory agents, pericardial tamponade is a lifethreatening condition requiring immediate therapy. Echocardiography and cardiac catheterization are important diagnostic tools and helpful in guiding therapies. Percutaneous catheter-based therapies, including pericardiocentesis and percutaneous balloon pericardiotomy, are safe and effective therapeutic modalities. Percutaneous balloon pericardiotomy is a relatively novel catheter-based technique that is gradually replacing the more invasive surgical pericardial window procedures. Pericardiectomy, on the other hand, remains the definitive therapy for certain conditions such as constrictive pericardial disease. This chapter presents an overview of acute pericardial disorders, with an emphasis on catheter-based techniques for pericardial space decompression.