**2.2 Contraindications**

Percutaneous pericardiocentesis is potentially life-saving and as such there are no absolute contraindications. It is, however, a technically challenging procedure with potential complications. The decision to intervene mandates risk–benefit analysis. Furthermore, surgery may offer a superior alternative to percutaneous intervention in some clinical scenarios (**Box 4**).

Haemopericardium secondary to aortic dissection, trauma (iatrogenic or otherwise) or ventricular free wall rupture post myocardial infarction are clear indications for emergency cardiothoracic surgery [8]. Furthermore surgical repair should not be

	- Use of anticoagulants
	- Raised INR/APTT/PT
	- Platelet count <sup>&</sup>lt;50,000

#### **Box 4.** *Situations warranting special consideration before performing pericardiocentesis.*

### *Percutaneous Approach to Pericardial Disease Management DOI: http://dx.doi.org/10.5772/intechopen.110635*

delayed by attempted percutaneous pericardiocentesis. Only in cases where surgery is delayed or the patient is too unstable for transfer to theatre should percutaneous intervention for controlled drainage of small amounts of haemopericardium be considered [9]. Surgery is also preferred for unstable septic patients with purulent pericardial effusions and in cases of loculated effusions [5].

Surgery offers numerous advantages that include access to large pericardial tissue samples for histopathological analysis, the ability to insert large bore drains (particularly important in purulent pericardial effusions) and the ability to drain complex loculated effusions. However, outside of the scenarios outlined above, surgical risk may outweigh benefit. In particular, general anaesthesia may cause hypotension and circulatory collapse in patients with restrictive cardiac physiology [10].

Percutaneous pericardiocentesis for diagnostic purposes alone is generally not recommended. Aetiology of an effusion can usually be determined based on clinical presentation, laboratory results and imaging without requiring pericardial fluid samples for analysis. Evidence suggests that in approximately 60% of pericardial effusions there is an identifiable underlying cause [11]. In the case of small effusions that do not meet criteria for therapeutic drainage, procedural risk is high.

Similarly percutaneous drainage is not recommended for idiopathic pericardial effusions without haemodynamic compromise. Published data indicate that such effusions respond well to anti inflammatory therapy or resolve spontaneously [5].
