Percutaneous Balloon Pericardiotomy Research Articles

Percutaneous Balloon Pericardiotomy and Window Creation for Treating Recurrent Massive Pericardial Effusion in Patients with Cancer: A Case Series and Literature Review

Cancer is the second leading cause of death worldwide, and pericardial effusion is relatively common in these patients. What constitutes the best therapeutic method for treating pericardial effusion in patients with cancer is controversial. Recent decades have witnessed the introduction of percutaneous balloon pericardiotomy, an effective and less-invasive method with lower recurrence rates than pericardiocentesis for draining pericardial effusion in patients with cancer who have a poor prognosis.We herein describe 2 patients with a history of metastatic melanoma and metastatic breast cancer, presenting with symptomatic massive pericardial effusions. The patients had experienced 2 episodes of cardiac tamponade in the preceding 4 to 5 months, treated via surgical drainage. In their current episode, they were both successfully treated via percutaneous balloon pericardiotomy, and there was no recurrence of significant pericardial effusion reported during the follow-up.

Treating cardiac tamponade due to malignant effusion with percutaneous balloon pericardiotomy: Back to the future.

Key points Percutaneous balloon pericardiotomy (PBP) involves creation of large hole in the pericardium with balloon inflation to avoid the need for a surgical “window” for treatment of malignant pericardial effusion. The procedure can be safely performed effectively with low complication rate and it can be repeated for recurrent pericardial effusion. The recurrence rate of pericardial effusion was 24.5% with a mean survival of 5.8 months. The subgroup surviving at least 1 month, likely had a longer median survival than the overall group, suggesting its value in a subgroup of patients.

Clinical outcome of patients with severe malignant pericardial effusion due to neoplastic disease undergoing percutaneous balloon pericardiotomy during COVID-19 pandemic

Abstract Background Neoplastic pericardial effusion (NPE) is a serious complication that occurs in the setting of advanced oncological disease and is associated with a high recurrence rate. Currently, pericardiocentesis (PCT) remains the first therapeutic option and the use of percutaneous balloon pericardiotomy (PBP) is limited to the treatment of recurrences. However, it is not known whether some aspects of the procedure during PBP lead to different outcomes in terms of survival and recurrence, and no such patients have been included in studies during COVID-19 pandemic. Purpose The aim is to analyses the success, complications and recurrence rate (defined as recurrence of NPE requiring PCT, PBP or surgical pericardial window (SPW) of both procedures (BP) in order to establish the optimal entry treatment for these patients. Methods This research analyzed the clinical characteristics and prognostic factors of patients with severe pericardial effusion of neoplastic etiology who underwent PBP during the COVID-19 pandemic. A prospective study was conducted involving 23 patients admitted between January 2020 and January 2022 for severe NPE who underwent PCT or PBP as initial treatment of NPE. Results We included 23 patients, 62.9% were male with a mean age of 51.2±14.9 years NPE was the first manifestation of the oncological process in 12 patients (52.1%) with lung cancer being the most frequently associated primary cancer (58.7%) followed by breast cancer in 12.7% of cases. A total of 26 procedures were performed, 10 PCT, 15 PBP, 1 SPW, with tumors cells identified in the pericardial fluid in 13.0% of cases. PCT was used as an entry point in 10 patients (43.5%), 6 patients were COVID-19 positive and PCT was performed as the first treatment. While PBP was chosen as the first therapeutic option in 13 patients (56.5%) (2 Re-PBP). The initial efficacy of the procedure was 93.1% and 92.2% respectively (p=0.88), with 1 complication occurring in the PBP group but not requiring scheduled SPW. In the former group, the percentage of recurrences was higher (34.7%; 8 recurrences in 10 patients) compared to patients treated with upfront PBP (8.6%; 2 recurrences in 13 patients), p=0.09. In addition, only one patient had to resort to surgery. When analyses according to the BP. used, the recurrence rate was 4.0 times higher for PCT (34.7 vs. 8.6% recurrences), although without reaching statistical significance (p=0.16). Conclusions The PBP is a simple, safe and effective technique for the treatment of NPE during the COVID-19 pandemic, in our series it was associated with a lower recurrence rate. Therefore, it could replace PCT in these patients during the COVID-19 pandemic as optimal first line treatment, providing better quality of life and reducing the need for re-interventions. Funding Acknowledgement Type of funding sources: None.

Percutaneous balloon pericardiotomy: efficacy in a series of malignant and nonmalignant cases

Objective: In the case of malignant pericardial effusion and cardiac tamponade, balloon pericardiotomy is an established minimally invasive option to the surgical creation of a subxiphoid pericardial window. Percutaneous balloon pericardiotomy effectively drains recurrent pericardial fluid by creating a pleuro (-abdominal-) pericardial communication. Design. A series of 26 patients with underlying malignant (n = 12) and nonmalignant (n = 14) diseases underwent percutaneous balloon pericardiotomy between 2008 and 2021. All interventions were done through a subxiphoid access under local anesthesia. Results. The mean survival in the malignant and nonmalignant groups was 1.2 versus 48.0 months, respectively (p < .001). There were neither severe periinterventional complications nor in-hospital deaths. In two patients with nonmalignant disease the surgical creation of a pericardial window was necessary during follow-up. The originally described procedure was modified by the removal of all catheters at the end of the intervention. The procedure was safe. It prevented immobility and facilitated an early discharge from the hospital. Conclusion. Our experiences show that percutaneous balloon pericardiotomy is a minimally invasive approach to successfully provide palliation in the group of patients with underlying malignant disease. On the other hand, we have shown that this technique is safe and feasible in the treatment of pericardial effusion based on nonmalignant disease. We think thereby that pericardial balloon pericardiotomy can be considered as a less invasive alternative to surgery in both groups of patients.

Retrospective comparison of percutaneous balloon pericardiotomy with pericardiocentesis versus pericardiocentesis alone for management of symptomatic pericardial effusions

Abstract Background Cardiac tamponade is a potentially life-threatening complication of pericardial effusion. Pericardiocentesis with drainage is the mainstay of treatment for patients with pericardial effusion and cardiac tamponade. Percutaneous balloon pericardiotomy (PBP) is an adjunct to pericardiocentesis that may alleviate the risk for recurrent effusion and repeat procedures. However, the efficacy of PBP plus pericardiocentesis compared to pericardiocentesis alone is not clear. Purpose We sought to determine whether PBP plus pericardiocentesis was associated with less recurrence of pericardial effusion than pericardiocentesis alone. Methods We conducted a single-centre retrospective analysis of patients ≥18 years old with non-iatrogenic pericardial effusion undergoing either pericardiocentesis alone or PBP plus pericardiocentesis for the first time. For PBP, a balloon was advanced over a guidewire until it crossed the pericardium and was then inflated until the balloon profile was fully expanded. Type of balloon used, and single or double balloon technique were left up to the operator. Recurrent pericardial effusion was defined as a large pericardial effusion on echocardiogram, pericardial effusion that caused hemodynamic compromise, or pericardial effusion that necessitated another intervention to drain at any time after initial procedure. Risk factors for recurrent pericardial effusion were also assessed. Results There were 208 patients who underwent pericardiocentesis, with 33 patients receiving PBP plus pericardiocentesis. In all patients, the rate of recurrent pericardial effusion was 15.9% and 15.2%, respectively (p=0.92). In patients with a cancer diagnosis at time of procedure, the rate of recurrent pericardial effusion was 17.8% and 16.7%, respectively (p=0.89). In patients with malignant pericardial effusion as confirmed by cytology, the rate of recurrent pericardial effusion was 20.4% and 13.3%, respectively (p=0.72). Patients with a connective tissue disease (CTD) had an increased odds ratio (OR) of recurrent pericardial effusion when compared to patients without a CTD (OR 3.19, 95% CI 1.31–7.77). Conclusions The results of this study suggest that PBP plus pericardiocentesis offers no significant benefit over pericardiocentesis alone at preventing recurrent pericardial effusion. This finding was true in all sub-groups, including patients with cancer and patients with malignant pericardial effusion. Patients with a CTD were three times more likely than patients without a CTD of having a recurrent pericardial effusion, independent of treatment strategy. Funding Acknowledgement Type of funding sources: None.

Single center experience of pediatric percutaneous balloon pericardiotomy.

Percutaneous balloon pericardiotomy is a percutaneous procedure that creates a window in the parietal pericardium by balloon dilation. The use of percutaneous balloon pericardiotomy has not been reported well in children. The objective of this study was to describe the single centre experience of percutaneous balloon pericardiotomy in children. This was a retrospective study to describe all the children aged <20 years undergoing percutaneous balloon pericardiotomy during an 18-year period (2001-2019). Patient characteristics, technical and ultimate procedural success, and repeat interventions were collected. A total of 13 percutaneous balloon pericardiotomy's were performed in 11 children at the median age of 12 years (range 1.8-19). The etiologies of pericardial effusion were post-pericardiotomy syndrome (n = 4), restrictive cardiomyopathy (n = 1), autoimmune diseases (n = 3), malignancy (n = 2), and idiopathic (n = 1). Two patients received two percutaneous balloon pericardiotomy. The technical success of percutaneous balloon pericardiotomy was 100% with no acute adverse events (balloon rupture or local bleeding). Five (45%) required re-intervention and ultimately three required a surgical pericardial window 6 to 35 days after the percutaneous balloon pericardiotomy. As a result, ultimate procedural success rate was 73% (8/11). Percutaneous balloon pericardiotomy was performed safely with high technical success in children. Percutaneous balloon pericardiotomy may be considered for recurrent and persistent pericardial effusion, before considering a surgical pericardial window.

Standardized approach to pericardial effusion management

The purpose of this review is to provide evidence-based, standardized recommendations on intervention for pericardial effusions. The appropriate management strategy is determined by effusion etiology. Pericardiocentesis under echocardiographic or fluoroscopic guidance is recommended for acute viral or idiopathic pericardial effusions. Due to recurrence risk, indwelling pericardial catheter placement is recommended for malignant pericardial effusions. Intrapericardial instillation of sclerosing or antineoplastic agents and percutaneous balloon pericardiotomy are alternative strategies. If less invasive options are not feasible or successful, pericardiotomy may be considered. Wide anterior pericardiectomy is indicated for relapse after repeated drainage. Potential procedural risks and therapeutic benefits are considered in determining the approach to intervention. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge, and Patient care.

Protocolo diagnóstico y tratamiento de la afectación pericárdica en las enfermedades neoplásicas

IntroductionThe diagnosis of pericardial disorder secondary to a neoplastic disease initially requires high diagnostic suspicion and then the systematic application of an aetiological study protocol. DiagnosisIf specific predictor factors for neoplastic disease are identified, drainage of pericardial fluid is recommended by percutaneous pericardiocentesis of heart surgery. Cytology of the pericardial fluid can establish pericardial neoplastic infiltration. However, occasionally a biopsy of the pericardium is required for anatomopathological study. TreatmentIf there is haemodynamic compromise, treatment will comprise drainage with emergency pericardiocentesis. Occasionally, staggered antineoplastic treatment is recommended, pericardiocentesis and intrapericardial instillation of cytotoxic or sclerosing agents. Percutaneous balloon pericardiotomy is a safe and effective procedure in the event of recurrent tamponade. In the advanced stages of the underlying neoplastic disease, the treatment of choice is palliative, exclusively to alleviate the patients’ symptoms.

Percutaneous balloon pericardiotomy: Treatment of choice in patients with advanced oncological disease and severe pericardial effusion.

Malignant pericardial effusion has a high recurrence rate after pericardiocentesis. We sought to confirm the efficacy and feasibility of percutaneous balloon pericardiotomy (PBP) as the initial treatment of choice for these effusions. Retrospective analysis of the clinical, echocardiographic, and follow-up characteristics of a consecutive series of PBP carried out in a single-center in patients with advanced cancer. Forty PBPs were performed in 35 patients with a mean age of 61.8years (55% females). Thirty-four patients had pathologically confirmed metastatic neoplastic disease (26 patients with tumoral cells in the pericardial liquid), 7 had previously required pericardiocentesis, and in the remaining patients PBP was the first treatment for the effusion. All patients had a severe circumferential effusion (29mm by mean on transthoracic echocardiography [TTE]), and most presented evidence of hemodynamic compromise on TTE. In all cases, the procedure was successful, there were no acute complications, and it was well tolerated at the first attempt. There were no infectious complications during follow-up. One patient developed a pseudoaneurysm in the right ventricle, even though no further treatment was required. Eight patients needed a new pericardial procedure: 3 had elective pericardial window surgeries and 5 had a second PBP. Eighty percent of patients died during follow-up (57days by mean from the PBP) regarding their oncological disease. PBP is a simple and safe technique that can be effective in the prevention of recurrence in many patients with severe malignant pericardial effusion. The characteristics of this procedure make it particularly useful in this group of patients to avoid more aggressive, poorly tolerated approaches, since they have a very poor prognosis regarding to their oncological disease.

CRT-800.48 Percutaneous Balloon Pericardiotomy: Treatment Of Choice In Patients With Advanced Oncological Disease And Severe Pericardial Effusion

Malignant pericardial effusion has a high recurrence rate after pericardiocentesis. We sought to confirm the efficacy and feasibility of percutaneous balloon pericardiotomy (PBP) as the initial treatment of choice for these effusions. Retrospective analysis of the clinical, echocardiographic, and

Evaluation of Safety and Feasibility of Percutaneous Balloon Pericardiotomy in Hemodynamically Significant Pericardial Effusion (Review of 10-Years Experience in Single Center).

Percutaneous balloon pericardiotomy (PBP) has been successful in managing large pericardial effusions, particularly in patients with malignant conditions. The objective of this study was to evaluate safety and feasibility of this procedure (PBP) in patients who had recurrent life threatening pericardial effusion at West Virginia University Hospital (WVUH). This is retrospective review of consecutive series of pericardial windows by PBP. This report entails our experience of 36 procedures performed from November 2002 to November 2012 by PBP. Thirty-six percutaneous balloon pericardiotomies were performed (20 males and 16 females) with a mean age of 58 ± 15 years. Lung cancer (50%) was the most common diagnosis with small cell type (29%) being most frequent. Other causes of pericardial effusion requiring PBP procedure included breast cancer (13.2%) and gastrointestinal cancer (15.7). Five patients had previously required pericardiocentesis in the past, and 31 patients had PBP as the first treatment for the pericardial effusion. There were no acute complications. The procedures were successful and well tolerated. Technical success of procedure was 100%. The 30-day survival was 81 percent and there were no infectious complications during follow-up. Percutaneous balloon pericardiotomy is safe and effective technique for the management of patients with severe recurrent life threatening pericardial effusion.

Pericardiotomia percutânea com cateter-balão como tratamento de efusão pericárdica recidivante em um cão – relato de caso

Pericardial effusion with cardiac tamponade leads to severe hemodynamic consequences that may result in cardiogenic shock and death. Emergency pericardiocentesis is a lifesaving maneuver necessary to alleviate clinical signs. Recurrent effusion is common in patients diagnosed with pericardial effusion due to neoplasia or of idiopathic etiology. Percutaneous balloon pericardiotomy is a non-invasive technique, performed under fluoroscopy guidance and that is considered safe and effective as palliative treatment for recurrent pericardial effusion. This article reports a percutaneous balloon pericardiotomy performed under serial radiographic and echocardiographic guidance in a dog diagnosed with recurrent pericardial effusion of unknown etiology. After the procedure, the dog had a lifespan of five months but was euthanized due to liver insufficiency.

Percutaneous balloon pericardiotomy in a child with recurrent pericardial effusions due to systemic lupus erythematosus

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

Initial management of severe malignant pericardial effusion with percutaneous balloon pericardiotomy

Purpose: Malignant pericardial effusion (MPE) is associated with adverse outcomes and presents a high rate of recurrence after pericardiocentesis. Various approaches have been reported for prevention of recurrences. However most of them are associated with significant morbidity or even mortality and required unnecessarily prolonged hospital stay. We sought to confirm the efficacy of percutaneous balloon pericardiotomy (PPB) as the initial treatment of choice for MPE. Methods: Retrospective analysis of the clinical, echocardiographic and follow-up characteristics of a consecutive series of PPB carried out in a single center in patients with advanced cancer. Results: Twenty-one PPB were performed in 19 patients with a mean age of 65±15 years. Seventeen patients had pathologically confirmed metastatic neoplastic disease and in another two patients there was a high radiological suspicion of it. Three patients had previously required pericardiocentesis, and in the remaining patients PPB constituted the first treatment for the MPE. All patients had a severe (>20mm) circumferential effusion and only one patient did not have evidence of hemodynamic compromise on echocardiography. In all cases the procedure was initially successful, there were no acute complications, and it was well tolerated at the first attempt. There were no infectious complications, and just one patient developed a large pleural effusion that did not require treatment. During the follow-up (median 74 [IQR 31.5-207.5] days), four patients required a new pericardial procedure: 2 elective pericardial window surgeries and 2 new PPB. Conclusions: PPB is a simple, safe procedure that can be effective in the prevention of recurrences in many patients with MPE. Based on the results and the poor prognosis of these patients we believe that PPB might be considered the initial treatment of choice for most MPE.

Percutaneous balloon pericardiotomy using the Inoue balloon for patients with recurrent pericardial tamponade : online article - case report

Recurrent pericardial effusion is often caused by pericardial metastases of extra-cardiac tumours. These effusions may be moderate to severe, leading to cardiac tamponade. The treatment is emergency pericardiocentesis but in spite of the initial success of that treatment, the effusions have high recurrence rates. Here we describe our experience of percutaneous balloon pericardiotomy (PBP) using the Inoue balloon for the management of three patients with malignant pericardial effusions secondary to lung cancer. In our clinic, three patients with recurrent pericardial effusion secondary to lung cancer were treated with percutaneous pericardiotomy with an Inoue valvuloplasty balloon catheter through the subxiphoid approach. Successful drainage with balloon pericardiotomy was achieved in all patients without severe complications. In all cases, only one pericardial site was dilated at least three times. During the four to six months of follow up, there were no recurrences of the effusion or tamponade. All patients were still alive. In our experience, PBP with the Inoue balloon appears to be a simple and safe procedure with a high success rate. PBP is an effective method for the management of patients with recurrent, large, malignant pericardial effusions.

EComment. Surgical or percutaneous pericardiocentesis in symptomatic pericardial effusion

It was with great interest that we read the recent article by Mirhosseini et al. [1]. They aimed to determine the risk factors affecting the survival rate of patients with symptomatic pericardial effusion who underwent surgical interventions. They showed that the underlying malignancy, the presence of a mass on computed tomography and echocardiographic findings compatible with tamponade are the three predictors of postoperative death. We believe that these findings will act as a guide for further studies. Thanks to the authors for their valuable contribution. Several methods have been described for fluid drainage including percutaneous pericardiocentesis, balloon pericardiotomy, or surgical drainage. More recently, echocardiography-guided pericardiocentesis has been shown to be a safe and effective method that can be performed at the bedside [2]. Echocardiography is also the primary imaging modality for the diagnosis and clinical follow-up of pericardial effusion, and has some advantages, including high sensitivity and specificity, lack of ionizing radiation, and low cost. All patients in the current study underwent surgical interventions [1]. Echocardiography-guided pericardiocentesis should be performed in patients with symptomatic pericardial effusion, if appropriate. Surgical approach should be recommended only in patients with very large and repeated chronic effusion, and/or if percutaneous therapy was not successful [3]. Conflict of interest: none declared.

Percutaneous Balloon Pericardiotomy as the Initial and Definitive Treatment for Malignant Pericardial Effusion

Introduction and objectivesMalignant pericardial effusion has a high recurrence rate after pericardiocentesis. We sought to confirm the efficacy of percutaneous balloon pericardiotomy as the initial treatment of choice for these effusions. MethodsRetrospective analysis of the clinical, echocardiographic, and follow-up characteristics of a consecutive series of percutaneous balloon pericardiotomies carried out in a single center in patients with advanced cancer. ResultsSeventeen percutaneous balloon pericardiotomies were performed in 16 patients with a mean age of 66.2 (15.2) years. Fourteen patients had pathologically confirmed metastatic neoplastic disease, 3 had previously required pericardiocentesis, and in the remaining patients percutaneous balloon pericardiotomy was the first treatment for the effusion. All patients had a severe circumferential effusion, and most presented evidence of hemodynamic compromise on echocardiography. In all cases, the procedure was successful, there were no acute complications, and it was well tolerated at the first attempt. There were no infectious complications during follow-up (median, 44 [interquartile range, 36-225] days). One patient developed a large pleural effusion that did not require treatment. Three patients needed a new pericardial procedure: 2 had elective pericardial window surgeries and 1 had a second percutaneous balloon pericardiotomy. ConclusionsPercutaneous balloon pericardiotomy is a simple, safe technique that can be effective in the prevention of recurrence in many patients with severe malignant pericardial effusion. The characteristics of this procedure make it particularly useful in this group of patients to avoid more aggressive, poorly tolerated approaches.

Pericardiotomía percutánea con balón como tratamiento inicial del derrame pericárdico grave de origen tumoral

Introduction and objectivesMalignant pericardial effusion has a high recurrence rate after pericardiocentesis. We sought to confirm the efficacy of percutaneous balloon pericardiotomy as the initial treatment of choice for these effusions. MethodsRetrospective analysis of the clinical, echocardiographic, and follow-up characteristics of a consecutive series of percutaneous balloon pericardiotomies carried out in a single center in patients with advanced cancer. ResultsSeventeen percutaneous balloon pericardiotomies were performed in 16 patients with a mean age of 66.2 (15.2) years. Fourteen patients had pathologically confirmed metastatic neoplastic disease, 3 had previously required pericardiocentesis, and in the remaining patients percutaneous balloon pericardiotomy was the first treatment for the effusion. All patients had a severe circumferential effusion, and most presented evidence of hemodynamic compromise on echocardiography. In all cases, the procedure was successful, there were no acute complications, and it was well tolerated at the first attempt. There were no infectious complications during follow-up (median, 44 [interquartile range, 36-225] days). One patient developed a large pleural effusion that did not require treatment. Three patients needed a new pericardial procedure: 2 had elective pericardial window surgeries and 1 had a second percutaneous balloon pericardiotomy. ConclusionsPercutaneous balloon pericardiotomy is a simple, safe technique that can be effective in the prevention of recurrence in many patients with severe malignant pericardial effusion. The characteristics of this procedure make it particularly useful in this group of patients to avoid more aggressive, poorly tolerated approaches.Full English text available from:www.revespcardiol.org/en

Percutaneous balloon pericardiotomy for the treatment of recurrent malignant pericardial effusion

Malignant disease with pericardial metastasis is one of the most common causes of recurrent pericardial effusion (PE) with tamponade. While surgical pericardiotomy in these patients is very morbid and may not be a viable option, a palliative treatment percutaneously with percutaneous balloon pericardiotomy (PBP) can be a preferred treatment. We report herewith a case of PBP technique done using our day-to-day catheterisation laboratory equipment.

Percutaneous Balloon Pericardiotomy for Recurrent Malignant Pericardial Effusion

An 82-year-old woman with stage 3 non-small cell lung cancer presented with a large pericardial effusion demonstrated by transthoracic echocardiography (TTE) (Figure 1, white arrow) (Supplemental Digital Content 1, http://links.lww.com/JTO/A157). She had a history of previous pericardial effusion treated with pericardiocentesis. She was evaluated and deemed high risk for definitive surgical treatment. Therefore, she underwent percutaneous balloon pericardiotomy, performed from a subxiphisternal approach under aseptic technique with fluoroscopic and echocardiographic guidance (Figures 2A–D) (Supplemental Digital Content 2–4, http://links.lww.com/JTO/A158, http://links.lww.com/JTO/A160, and http://links.lww.com/JTO/A161). Six hundred milliliters of serous fluid was aspirated, resulting in immediate symptomatic improvement. Three months later, TTE revealed a small stable effusion with no diastolic right atrium/right ventricle/collapse.FIGURE 2.Fluoroscopic images detailing the percutaneous balloon pericardiotomy procedure from confirmation of position using contrast (A); Inoue balloon used to dilate the pericardial space inflated repeatedly until the waist of the pericardium over the balloon was lost with consequential decrease in effusion size (B–D).View Large Image Figure ViewerDownload (PPT) Malignant disease is a common cause of pericardial effusion with incidences ranging from 1 to 20% in all cancer patients.1Kline I Cardiac lymphatic involvement by metastatic tumour.Cancer. 1972; 29: 799-808Crossref PubMed Scopus (93) Google Scholar, 2Lockwood WB Broghamer Jr, WL The changing prevalence of secondary cardiac neoplasms as related to cardiac therapy.Cancer. 1980; 45: 2659-2662Crossref PubMed Scopus (33) Google Scholar Management is challenging with recurrence rates of 13 to 50%3Galli M Politi A Pedretti F et al.Percutaneous balloon pericardiotomy for malignant pericardial tamponade.Chest. 1995; 108: 1499-1501Crossref PubMed Scopus (27) Google Scholar after pericardiocentesis and patients often unsuitable for surgical intervention. Percutaneous balloon pericardiotomy is a simple and safe minimally invasive alternative to drain pericardial effusions.