What is percutaneous balloon pericardiotomy?

A fibrous sac called the pericardium surrounds the heart. The pericardium consists of two thin layers with a small amount of fluid between them. The fluid reduces friction between the layers as they rub against each other. In some cases, extra fluid can build up between these layers. This results in a condition called pericardial effusion. If too much fluid builds up, it can make it difficult for the heart to work properly. Percutaneous balloon pericardiotomy (PBP) is a procedure to drain excess fluid that has collected in the sac around the heart. The procedure uses a long thin tube with a balloon attached. Fluid drains out through the tube.

During PBP, a healthcare provider inserts a needle through the chest wall and into the tissue around the heart. Once the needle is inside the pericardium, the healthcare provider removes the needle and replaces it with a long, thin tube called a catheter. This tube has an inflatable balloon at its tip. Repeated inflation of the balloon creates a small hole or “window” in the pericardium. When the hole is large enough, the healthcare provider removes the catheter and balloon and replaces them with a new catheter for final draining. This allows fluid to drain out of the pericardium, which improves heart function.

Why might I need percutaneous balloon pericardiotomy?

Many different types of medical problems can cause an abnormal fluid buildup around the heart. These include:

• Autoimmune disease

• Cancer

• Infection

• Injury

The fluid buildup can cause shortness of breath, dizziness, nausea, low blood pressure, and chest pain. Sometimes this is treatable with medicines. In other cases, this abnormal fluid is life-threatening and requires urgent drainage.

There are several ways to manage this abnormal fluid buildup. For example, sometimes healthcare providers do a catheter pericardiocentesis. For this, the healthcare provider uses a needle and catheter to drain the fluid from around the heart. Other times, surgery may be done to remove part or all of the pericardial sac.

Healthcare providers mainly use PBP to treat repeated pericardial effusion due to cancer. PBP is used less commonly for very large pericardial effusions of other types. Healthcare providers are more likely to use PBP in people who have needed repeated pericardiocentesis.

PBP decreases the chance that the fluid buildup will happen again. This fluid buildup is more likely to happen if you have just pericardiocentesis. PBP is much less invasive and has fewer risks of complications than surgery. This makes it an especially important option for people with cancer. Currently, PBP may not be available at every surgical center. Talk with your healthcare provider about whether the procedure would make sense for you.

What are the risks of percutaneous balloon pericardiotomy?

PBP is a very safe and effective procedure. Complications do sometimes develop, though. Your risk varies according to your overall health, your other medical problems, and the anatomy of the heart, fluid, and pericardium. Possible risks include:

• Air in the chest cavity (pneumothorax)

• Excess bleeding, which might keep the heart from beating properly

• Fluid around the lungs (pleural effusion)

• Infection

• Puncturing of the heart

• Death

Talk with your healthcare provider about your particular risks.

The procedure does not seem to be any more risky than catheter pericardiocentesis. The procedure also does not seem to increase the rate at which cancer spreads in the body.

How do I get ready for percutaneous balloon pericardiotomy?

Ask your healthcare provider how to prepare for PBP. You will probably have to avoid eating and drinking for a certain amount of time, such as 6 hours or more, before the procedure. Check with your healthcare provider about whether you need to stop taking any medicines before the procedure.

The healthcare provider may want some extra tests before the procedure. These might include:

• Chest X-ray

• Electrocardiogram (ECG), to check the heart rhythm

• Blood tests, to check general health

• Echocardiogram, to check blood flow through the heart and view the fluid around the heart

• CT scan or MRI, if the healthcare provider needs more information about the heart

What happens during percutaneous balloon pericardiotomy?

Talk with your healthcare provider about what will happen during your PBP. A cardiologist and a team of other healthcare professionals will do the procedure, usually in a heart catheterization lab. The following is a description of just the PBP. In general:

• You will be awake. An IV (intravenous) line will be placed in your hand or arm. You will probably receive medicine to make you sleepy before the procedure starts.

• Your vital signs will be carefully monitored.

• An echocardiogram will be done to view the heart and pericardium.

• A local anesthetic will be applied at the needle insertion site, below the breastbone.

• The healthcare provider will insert the needle through the skin. The needle will be guided to the pericardial sac with the help of an echocardiogram or X-ray imaging (fluoroscopy).

• Once the needle is in the correct area, it will be removed and replaced with a long, thin tube called a catheter. This catheter has a balloon at its tip.

• The healthcare provider will carefully inflate the balloon over several minutes. This may be a little painful, but pain medicine is available if you have pain. The procedure may be repeated with two balloons to create two windows in the pericardium.

• The healthcare provider will deflate the balloons and remove the catheters. Usually, the catheters will be replaced with another set of catheters that will remain in place for a while as the fluid continues to drain.

• When enough fluid has drained, the catheters will be removed.

• Pressure will be applied over the catheter insertion site to prevent bleeding.

What happens after percutaneous balloon pericardiotomy?

Ask your healthcare provider about what to expect after the procedure. In general, after your PBP:

• You may be groggy and confused for a short time.

• Your vital signs, such as your heart rate, blood pressure, breathing, and oxygen levels, will be carefully monitored.

• You may have a chest X-ray and an echocardiogram to view the hole in the pericardium and make sure you don’t have fluid buildup in the lung.

• You will probably need to stay in the hospital for one or more days.

After you leave the hospital:

• You should be able to resume normal activities relatively soon, but you will need to avoid vigorous exercise until your healthcare provider says you are ready.

• Make sure you keep all your follow-up appointments.

• Call the healthcare provider if you have fever, increased drainage from the needle insertion site, chest pain, shortness of breath, or any severe symptoms.

• Follow all instructions your healthcare provider gives you for medicines, exercise, diet, and wound care.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure