الفهرس 
Aim of The WorkOnly 14 pages are availabe for public view
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Abstract
The diagnosis of pericardial effusion is generally performed by echocardiography, which also enables semi quantitative assessment of the pericardial effusion size and its hemodynamic effects. The echocardiographic assessment of pericardial effusion volume and severity rely on linear measurements of the largest width of the effusion. This approach is limited due to variations in heart size and the asymmetry of many effusions. Quantification of pericardial effusion volume using the method of disks more accurate and better to be used.
The treatment of cardiac tamponade involves drainage of the pericardial fluid, preferably by needle pericardiocentesis. There are three approaches of puncture site to perform percutaneous pericardiocentesis: the apical, the subcostal or the parasternal approach. The Mayo Clinic advocates selecting the approach based purely on echocardiographic findings and defines the optimal entry site as the point where the fluid accumulation is maximal and pericardial space is closest to the probe, with no intervening vital organs. This site is more often identical to para-apical than subcostal.
Furthermore, an observational series on echo-guided closed pericardiocentesis demonstrated a minor complication rate and a greater success rate when the entry site was echocardiographically selected rather than when the sub-xiphoid approach was routinely used.
This study is a prospective multi-center study that included 200 patients with pericardial effusion or cardiac tamponade presented to the National Heart Institute and Benha University Hospital during the period from May 2019 till June 2022. All patients were treated by Echo-guided pericardiocentesis.
All patients were subjected to detailed medical history, complete physical examination, 12 leads surface ECG, laboratory investigations, echocardiography and echocardiography guided pericardiocentesis. Patients admitted in the CCU and followed during their hospital stay.
At beginning of the analysis, we divided the data of the patients into group 1 (which included 100 patients with pericardial effusion or cardiac tamponade and treated by Echo-guided pericardiocentesis through new modified para-apical technique) and group 2 (which included 100 patient patients with pericardial effusion or cardiac tamponade and treated by Echo-guided pericardiocentesis through Sub-xiphoid technique).
The results of comparison between them were:
1. The distance between skin and pericardium was highly significant variable between group 1 and group 2. Also the skin to epicardium distance was highly significant between the two groups.
2. The incidence of overall complications in group 1 was 8% while the incidence in group 2 was 20% with statistically significant between the two groups.
3. The incidence of major complications in group 2 was 10% while in group 1 was only 2%.
Then a correlation analysis was done and we found that the pericardial fluid volume by ECHO was strongly positive correlated to the pericardial fluid volume by pericardiocentesis.
Based on the correlation analysis we did the regression analysis. We found that pericardiocentesis using Volume calculated by ECHO explained (R2=96.2%) of the pericardial fluid volume by pericardiocentesis. The linear model for predicting pericardial fluid volume by pericardiocentesis using Volume calculated by ECHO is given by [Pericardial fluid volume by pericardiocentesis (V) = 1.036 x pericardial fluid volume by echo (E) + 51.77].
Finally in conclusion, the biplane Simpson’s method of disks can simply, quickly and accurately quantify pericardial effusion volume by two dimension echocardiography. This method may help in clinical decision making regarding the need for and timing of pericardiocentesis. Also, we conclude that echocardiography guided pericardiocentesis with the apical approach especially with novel tips and tricks should be considered in suitable cases as it is readily performed at the bedside without the need for catheterization laboratory, with a high success rate and fewer complications.