Lesson from Management of Left Ventricular Pericardiocentesis Catheter Malposition

Pericardiocentesis is a critical diagnostic and therapeutic intervention for pericardial effusion. A rare but severe complication involves inadvertent penetration of the drainage catheter into the cardiac chambers, which can lead to catastrophic sequelae such as ventricular septal perforation and cardiac tamponade. Here is the case of a 51-year-old female patient presenting with an undiagnosed fever who developed these complications following echocardiography-assisted pericardiocentesis via a subxiphoid approach. A 10.2 Fr pigtail drainage catheter was inadvertently advanced through the right ventricular free wall, traversed the interventricular septum, entered the left ventricle, and came to rest subjacent to the aortic valve. The surgical repair remained redundant after manual compression of the puncture site, with the result of automatic hemostasis in the right ventricular free wall and closure of interventricular perforation. This case demonstrates that vigilant intraoperative monitoring with immediate surgical standby represented a potential, prudent, and resource-efficient management strategy for such a complication.