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The shortest path to the heart - apical versus subxiphoid pericardiocentesis for treating pericardial effusion
Session:
Sessão de Posters 51 - Circulação pulmonar, pericárdio e cuidados agudos
Speaker:
Raquel Montalvão
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
18. Pericardial Disease
Subtheme:
18.4 Pericardial Disease – Treatment
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Raquel Montalvão; Mariana Silveira Ramos; Margarida Matias; Maria Inês Soares; Gonçalo Cunha; Ana Rita Bello; João Presume; Jorge Ferreira; Catarina Brízido
Abstract
<p><strong>Background</strong>: Pericardiocentesis is the standard procedure for diagnosing and treating pericardial effusion. Although the subxiphoid is the traditional access site, the widespread use of ultrasound allows alternative windows tailored to effusion location and patient anatomy. Despite its increasing use, there is scarce data detailing the apical approach. </p> <p><strong>Purpose</strong>: We present our institutional experience with pericardiocentesis, comparing the effectiveness, safety and outcomes of the apical and the subxiphoid aproaches. </p> <p><strong>Methods</strong>: Retrospective analysis of patients undergoing pericardiocentesis between 2022 and 2025 at a tertiary cardiac care center. Patients were categorized according to access site: apical or subxiphoid. Data was collected from electronic health records. Statistical comparisons were performed using two-sided Fisher’s exact test. </p> <p><strong>Procedural details</strong>: Bedside ultrasound was used to select the approach, favoring the largest effusion window with the lowest risk of perforating adjacent structures. For the apical approach, the entry site was located 1–2 cm lateral to the apex beat, between the 5th and 7th intercostal spaces. A needle was advanced above the corresponding rib’s upper border, to avoid injury to the intercostal neurovascular bundle. Aspiration of pericardial fluid confirmed entry into the pericardial space and ultrasound assessed correct needle placement. </p> <p><strong>Results</strong>: A total of 45 patients underwent pericardiocentesis, 14 (31%) performed via the apical and 31 (69%) via the subxiphoid approach. The apical group had a higher percentage of women but body mass index was comparable. Hemodynamic instability was more common in the subxiphoid group. The overall success rate was 91% and severe complications occurred in four patients (8%), with no statistically significant difference between the two techniques. No pneumothorax occurred. In the apical group, one case was complicated with left ventricular puncture. In the subxiphoid group, there were three ventricular punctures (one right and two left), with one patient going into cardiac arrest, requiring emergent sternotomy with subsequent death. Overall (p-value 0.519) and in-hospital survival (p-value 1), showed no statistically significant differences (median follow-up: 260 [75-121] days). </p> <p><strong>Conclusions</strong>: Our institutional experience supports the apical approach as a safe and effective alternative for the traditional technique, enabling tailored treatment to patient’s effusion and anatomy. </p>
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