Pericardiocentesis Surgery for Mesothelioma Patients

Pericardiocentesis Surgery for Mesothelioma Patients | Treatment
By Npatchett – Own work, CC BY-SA 4.0

Pericardiocentesis is a medical procedure that addresses the accumulation of excess fluid in the pericardium, the thin sac surrounding the heart. It primarily targets pericardial effusion, the abnormal buildup of fluid within the pericardium.

Pericardial effusion can manifest as a symptom of various heart-related diseases, including pericardial mesothelioma. In individuals without health issues, the pericardium contains a small amount of fluid, leaving ample room for the heart’s normal rhythmic contractions. However, pericardial effusion disrupts this equilibrium, causing additional fluid to accumulate within the pericardium, exerting undue pressure on the heart. Pericardiocentesis employs a needle to drain a portion of this surplus fluid, allowing the heart to regain its regular rhythm.

Pericardiocentesis can be administered as both an emergency procedure to alleviate acute cardiac pressure and as a non-critical intervention to relieve symptoms such as breathlessness or chest pain caused by pericardial effusion.

Cardiac Tamponade

In cases where pericardial effusion escalates in severity, it can lead to cardiac tamponade. This critical condition arises when fluid buildup exerts so much pressure that the heart struggles to function normally, causing a drop in blood pressure despite an elevated heart rate. Also known as pericardial tamponade, it can result from cancer, infections, injuries, or certain diseases.

Common culprits behind pericardial effusion and cardiac tamponade encompass advanced cancer, autoimmune diseases, heart attacks, heart cancer, heart failure, hypothyroidism, inflammation or infection of the pericardium, kidney failure, pericardial mesothelioma, and tuberculosis.

Pericardiocentesis in Mesothelioma

Pericardial effusion frequently accompanies pericardial mesothelioma, leading oncologists to recommend pericardiocentesis for symptomatic relief. This procedure can alleviate symptoms like breathlessness, chest pain, swelling, and increased heart rate. Some mesothelioma patients may experience immediate relief from symptoms, particularly improved breathing, during or immediately following the procedure.

It is vital to note that pericardiocentesis cannot cure mesothelioma; instead, it focuses on symptom management. Remarkably, this procedure boasts an exceptionally high success rate in fluid removal. Although there are potential side effects, the life-saving capabilities of pericardiocentesis typically surpass the accompanying risks.

While pericardiocentesis can be employed as an emergency measure, it also plays a crucial role in palliative care by alleviating pain and pressure around the heart, thereby enhancing patients’ comfort.

The Pericardiocentesis Procedure

Pericardiocentesis is a minimally invasive procedure that is typically conducted on an outpatient basis. The exact process may vary, but it commonly involves the following steps:

  1. Ultrasound Guidance: Utilizing ultrasound to determine the optimal needle placement.
  2. Local Anesthesia: Numbing the area where the needle will be inserted.
  3. Needle Insertion: Inserting the needle into the pericardium (note that the needle does not penetrate the heart). In cases involving larger fluid volumes, a catheter may be inserted to facilitate drainage.
  4. Fluid Extraction: Draining the accumulated fluid from the pericardium.
  5. Needle or Catheter Removal: Extracting the needle or catheter upon completion of fluid drainage.
  6. Clean-Up and Bandaging: Cleaning and bandaging the insertion site.

It is essential to understand that the emergency pericardiocentesis procedure may differ in execution. Patients should consult their mesothelioma doctors to gain clarity on the procedure, enabling them to prepare adequately.

Preparation for Pericardiocentesis

Patients anticipating pericardiocentesis can take several preparatory steps. The medical team will provide specific instructions, which patients should diligently follow.

Typically, fasting for about eight hours before the procedure is advised, with potential exceptions for clear liquids. Patients should verify their fasting instructions with their healthcare providers.

At the commencement of the appointment, healthcare providers establish an intravenous (IV) line for medication administration. Simultaneously, they prepare the needle injection site, which may involve hair removal, skin cleaning, and disinfection. Monitoring devices are often employed to measure vital signs, including blood pressure, breathing rate, heart rate, blood oxygen levels, and electrocardiogram (ECG or EKG) electrodes to monitor heart electrical signals.

Patients should familiarize themselves with the procedure details by discussing them with their doctors. Additionally, they should inquire about insurance coverage to confirm whether pericardiocentesis and related procedures are included in their policy. Coverage can vary significantly among insurance plans, and patients can seek guidance from cancer centers or medical providers to gain a deeper understanding of their coverage specifics.

Post-Pericardiocentesis Expectations

The post-pericardiocentesis experience can be unique for each patient, contingent on their underlying health conditions and individual requirements. The healthcare team will provide guidance on what to anticipate during and after the procedure.

Providers often conduct a post-procedure ultrasound to confirm the successful removal of an adequate amount of fluid. In some instances, the drained fluid may undergo additional testing. However, it’s essential to note that pericardial mesothelioma is challenging to detect through fluid analysis.

Recovery duration following pericardiocentesis can vary widely, influenced by factors such as cancer stage, concomitant health issues, and individual circumstances. Mesothelioma patients are encouraged to maintain open communication with their care team, seeking guidance for any questions or concerns that may arise during the recovery process.

Recurrent Pericardial Effusions

Recurrence of pericardial effusions is a possibility for some patients, signifying a reappearance of fluid buildup after pericardiocentesis. In such cases, patients may become candidates for a pericardiectomy, a surgical procedure designed to prevent future fluid accumulation.

A pericardiectomy, also referred to as pericardial stripping, entails the partial or complete removal of the pericardium. This surgical intervention is considered for patients who have experienced multiple episodes of pericardial effusions.

Benefits of Pericardiocentesis for Mesothelioma Patients

Pericardiocentesis offers several advantages for mesothelioma patients:

  1. Minimally Invasive: Pericardiocentesis is a less invasive alternative to common mesothelioma surgeries. It is characterized by simplicity, rapidity, and uncomplicated preparation and recovery.
  2. Symptom Relief: The procedure effectively eases symptoms linked to pericardial effusion and pericardial mesothelioma, such as pain and shortness of breath. Some patients may experience symptom relief during the procedure itself.
  3. Causative Clarity: Pericardiocentesis aids in understanding the underlying cause of fluid buildup, particularly in cases of pericardial mesothelioma, where it is often linked to pericardial tumors or, in other mesothelioma types, metastasized tumors.

Side Effects and Risks of Pericardiocentesis

Pericardiocentesis is generally a safe medical procedure, with risks minimized through imaging assistance, such as ultrasounds or fluoroscopy, for precise needle placement.

Possible complications include:

  • Air in the chest cavity
  • Damage to surrounding tissues (major blood vessels, heart, liver, lungs, pericardium, and stomach)
  • Excessive bleeding
  • Infection or sepsis

Patients should consult their care team regarding potential side effects and report any post-procedure symptoms promptly. Open communication with healthcare providers is essential to ensure a smooth recovery process.