Percutaneous balloon pericardiotomy (PBP) is a procedure done to drain excess fluid in the sac around the heart. The procedure uses a long thin tube with a balloon attached. Fluid is drained out through the tube.
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 two 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. PBP allows this fluid to drain and helps prevent future fluid buildup.
During PBP, a doctor inserts a needle through the chest wall and into the tissue around the heart. Once the needle is inside the pericardium, the doctor removes it 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 doctor removes the catheter and balloon replaces them with a new catheter for final draining. This allows fluid to drain out of the pericardium, which improves heart function.
Many different types of medical problems can cause an abnormal fluid buildup around the heart. These include:
- Autoimmune disease
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 doctors do a catheter pericardiocentesis. In this procedure, the doctor uses a needle and catheter to drain the fluid from around the heart. Other times, doctors might do surgery to remove part or all of the pericardial sac.
Currently, doctors mainly use PBP to treat repeated pericardial effusion due to cancer. Doctors use it less commonly for very large pericardial effusions of other types. They are more likely to use it 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. Ask your doctor if the procedure would make sense for you.
PBP is a very safe and effective procedure. Complications do sometimes develop, though. Specific risk factors vary according to your overall health, your other medical problems, and the anatomy of the heart, fluid, and pericardium. Ask your doctor about your particular risks. Possible risks include:
- Air in the chest cavity (pneumothorax)
- Excess bleeding, which might keep the heart from beating well
- Fluid around the lungs (pleural effusion)
- Puncturing of the heart
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.
Ask your doctor how to prepare for PBP. You will probably have to avoid eating and drinking for 6 hours or more before the procedure. Ask the doctor whether you need to stop taking any medicines before the procedure.
The doctor may want some extra tests before the procedure. These might include:
- Chest X-ray
- EKG or 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 doctor needs more information about the heart
Talk with your doctor 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. Usually, pericardiocentesis takes place before PBP. The following is a description of just the PBP. In general:
- You will be awake. An IV will be inserted 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 doctor 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 doctor will carefully inflate the balloon over several minutes. This may be a little painful, but you can have pain medicines. The procedure may be repeated with two balloons to create two windows in the pericardium.
- The doctor 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 heart 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.
Ask your doctor about what to expect after the procedure. In general, after your PBP:
- You may be groggy and disoriented.
- 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 avoid vigorous exercise until your doctor says you are ready.
- Make sure you keep all your follow-up appointments.
- Call the doctor if you have fever, increased draining from the needle insertion site, chest pain, or any severe symptoms.
- Follow all instructions your healthcare provider gives you for medicines, exercise, diet, and wound care.
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 will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
January 16, 2018
Pericardial Disease associated with malignancy. UpToDate., Essential Interventional Cardiology. Caplin, L. J. 2008. 36:481-87., When Do You Need to Do Pericardiocentesis? Kern, M. Cath Lab Digest. 2014. 22(9), Percutaneous Balloon Pericardiotomy for Recurrent Malignant Pericardial Effusion. Journal of Thoracic Oncology. 2011. 6(12)
Sudheendra, Deepak, MD,Cunningham, Louise, RN