High frequency ultrasound‐guided pericardiocentesis performed in the sitting position: A novel apical approach

FIGURE 1. Representation of large symptomatic MPE in a 72‐year‐old man with a history of lung cancer. (A) Conventional echocardiogram performed before the procedure showed a large pericardial effusion. The maximal anterior depth was 29 mm. (B) The apical view was obtained with the high frequency probe and the depth adjustment was 4 cm. The needle is continuously visualized by a high frequency ultrasound while entering the pericardial space. (C) After the needle penetrated through the pericardial space, a j‐tipped guidewire was gently advanced through the needle

FIGURE 2. Schematic of the patient in the sitting position during pericardiocentesis. (1) The patient was allowed to sit on chair with a backrest. (2) The patient's stability was ensured (e.g., with aid from an assistant or nurse). (3) The patient's left arm was extended above the heads to stretch the intercostal space

FIGURE 3. Moderate symptomatic MPE in a 46‐year‐old woman with a history of breast cancer. (A) Conventional echocardiogram performed before the procedure showed a moderate pericardial effusion. The maximal anterior depth was 19 mm. (B) The needle is continuously visualized by a high frequency ultrasound while entering the pericardial space. A safe approach to needle advancement under high frequency ultrasound guidance while continuous visualization of the needle insertion, superficial part of the pericardium, intercostal vessels and myocardium

FIGURE 4. Presentation of the maximum inserted wide angle approach. (A) illustrates a moderate PE, the maximal anterior depth was 14 mm. (B) To prevent damage to the myocardium, the maximum inserted wide angle between the probe and the needle was chosen. The maximum wide angle allowed a better visualization of the needle in the short space between the probe and the pericardium sac. (C) The needle and the guidewire into the pericardial cavity was approximately parallel to the myocardium