Pericardiocentesis As a Treatment of Choice For Animal With
Cucu K. Sajuthi , Maulana ArRaniri Putra, Piprim B Yanuarso*, Suswanto, Bambang Sulistyo, Endang Yuli Astuti, Herlina, and Royama Sari.
Praktek Dokter Hewan Bersama (PDHB) 24 jam drh. Cucu K. Sajuthi dkk
(24 HRS Veterinary Clinic Drh Cucu K. Sajuthi and Associate)
Jl. Sunter Permai Raya, Ruko Nirmana Sunter Asri Tahap III Blok J-1 No.2
*) Rumah Sakit Cipto Mangunkusumo, Jakarta
Pericardial effusion is a condition when excess or abnormal fluid accumulation occurs in the pericardial space. This disease is the most common pericardial disorder and it occurs most often in dogs. Most pericardial effusion in dog are sanguinous or serosanguinous. The fluid usually appears dark red. Mostly red blood cells are found on cytological diagnosis but, reactive mesothelial, neoplastic, or other cells may be seen (Abbott, 2000).
The treatment of pericardial effusion is very different from other causes of right-side heart failure. Positive inotropic drugs do not ameliorate the signs of tamponade. Pericardiocentesis is the therapeutic procedure of choice and also provides diagnostic information. Administration of diuretic or vasodilatators without pericardiocentesis may cause further hypotention and cardiogenic shock (Nelson and Couto, 2003).
Brownie, a male 11-years old Golden Retriever was first presented to our clinic with fatigue, panting and the dog had a sudden collapse history. The physical exam showed that respiratory rate was increased (100 beats/ minute) but the body temp was within the normal range (38.7oC). The diagnostic approach was X-ray, with the result that the heart was very big, almost fully filled the chest cavity. We suggested to the owner to bring the dog in the next day to meet our vet with special interests in cardiology, for an ECG and Ultrasound. The ECG showed shortened complex of QRS waves. The Ultrasounding showed the presence of water in the pericardium space in a large amount. The definitve diagnosis of Brownie was pericardial effusion. The prognosis was dubius to infausta. The therapy given were Lasix® , Omega 3 plus® and TF advance® . We planned to perform pericardiocentesis as soon as possible and the owner agreed. Two days later, the dog came to our clinic for pericardiocentesis.
Pericardiocentesis is the treatment of choice for initial stabilization of animals with cardiac tamponade. Pericardiocentesis is a relatively safe procedure when carefully performed. Removal of even small amounst of pericardial fluid can markedly decrease intrapericardial pressure in animals with tamponade (Nelson and Couto, 2003).
Brownie was sedated with intravenous administration of penthotal and the maintenance was inhalation of isoflurans. The position was Right-Lateral recumbency and the tap was performed from underneath. Pericardiocentesis from the right side minimizes the risk of trauma to the lung (because of the cardiac notch) and major coronary vessels (which are located mostly on the left) (Nelson and Couto, 2003). The skin was shaved over a wide area especially between costae three to eight, then the area was cleaned with alcohol 70% and iodine tincture 20%. We put markers in the 1/3 ventral part of intercostae three to four. The incision site was in the marked regio. The incision was about five cm dorso-ventral length. After intercostal muscles were visible, a #16 and 5″ intravenous catheter was poked through intercostal muscles to reach the pericard, with the guidance of ultrasound. After that the needle from the IV catheter was pulled out. The next step was to aspirate to make sure of the proper position of the IV catheter. Then a 0.18 short wire was inserted to the IV catheter and the IV catheter was pulled out but the short wire stayed inside. The function of the short wire was as a direction to the pericardial space. After that 4s radial sheath was inserted to the wire until it reached pericardial space. Then the wire was pulled out and the sheath left inside. After that a 150 cm guide wide terumo® was inserted to the 4s pig tail catheter, then put onto radial sheath in the chest cavity. The wire was pulled out, 4s radial sheath and pig tail catheter were fixated to the skin with thread. Pericardiosintesis was then performed. We collected 385 ml hemoserous liquid from Brownie, and we sent it to the lab for further diagnosis. After 385 ml of liquid was withdrawn by pericardiocentesis, the ECG showed that the amplitude of the complexes were now increased. On day two we collected another 95 ml hemoserous liquid. The volume of the liquid decreased everyday until day five. On day five there was no moreliquid that we could aspirate. After the absence of liquid was confirmed, we took the catheter out. To prevent infection we gave the dog cefadroxil and also omega 3® and TF advance® as a supplement.
The morphological diagnosis from cytological insection of the liquid that we had collect on pericardial space were hemorrhagic effusion with atypical cells. The atypical cells could be tumor cells or reactive mesothelial cells that correlated with hemorrhagic effusion. The differential diagnosis for this case were heart based tumor or hemangiosarcoma. Both of the diseases can cause hemorrhagic effusion. We had to take a new radiographic for the chest, and the result showed that the heart’s size was smaller than the previous radiographic.
Pericardiocentesis is the most successful method to treat pericardial effusion. Careful procedures will minimize the risks.
Abbott JA. 2000. Small Animal Cardiology Secrets. Hanley&Belfus. .
Nelson RW, Couto CG. 2003. Small Animal Internal Medicine 3rd ed. Mosby inc.
Picture 1. The dorso-ventral position of the thorax region before (A) and after (B) pericardiocentesis. (Personal documentation, 2010)
Picture 2. The ECG of Brownie before (left) and after (right) pericardiocentesis
(Personal documentation, 2010)
Picture 3. USG of brownie’s heart before the pericardiocentesis