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Bernhard Maisch - One of the best experts on this subject based on the ideXlab platform.
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Alternative Techniques for Pericardiocentesis
Interventional Pericardiology, 2020Co-Authors: Bernhard Maisch, Arsen D. Ristić, Petar M Seferovic, Teresa S M TsangAbstract:Pericardiocentesis of moderate, small or loculated Pericardial effusions is a controversial issue. It should not be routinely performed if the patient is not symptomatic and effusion is spontaneously resolving and unless further diagnostic and/or therapeutic options are available (e.g. pericardioscopy, epicardial or Pericardial Biopsy, application of intraPericardial treatment). In addition, access to the small or moderated effusions requires a learning curve. Several experimental and few clinical concepts have been developed for access of a small Pericardial effusion or normal pericardium. These procedures will be reviewed in the following sections.
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Pericardiosopy: Endoscopic Insight in Pericardial and Epicardial Pathology
Interventional Pericardiology, 2020Co-Authors: Bernhard Maisch, Arsen D. Ristić, Petar M. Seferović, Teresa S M TsangAbstract:Percutaneous pericardioscopy is a diagnostic tool for the endoscopic visualization of lesions in both the epicardium and parietal pericardium. It enables safe and efficient targeted epicardial and parietal Pericardial Biopsy and provides the cardiologist with not only macroscopic but also microscopic evidence of pathologic changes [1].
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Pericardioscopy and epi- and Pericardial Biopsy—a new window to the heart improving etiological diagnoses and permitting targeted intraPericardial therapy
Heart Failure Reviews, 2013Co-Authors: Bernhard Maisch, Heinz Rupp, Arsen Ristic, Sabine PankuweitAbstract:The etiology of Pericardial effusions remains unresolved in many cases because not the full spectrum of diagnostic methods including cytology, histology, immunohistology and PCR on cardiotropic agents, which are currently available, used in many institutions. After comprehensive clinical workup and use of imaging methods, such as echocardiography and cardiac MRI, pericardiocentesis and epicardial and Pericardial Biopsy were carried out under pericardioscopical control of the Biopsy site. Biopsies and fluid were evaluated by cytological, histological, immunological and molecular (PCR) methods in 259 patients of our tertiary referral center following an identical clinical pathway, diagnostic and therapeutic algorithm in all cases. A standard clinical pathway and the same diagnostic and therapeutic algorithms were used in all cases. When all methods are applied to patients with Pericardial effusions, “idiopathic” Pericardial effusion is no longer a relevant diagnosis. Autoreactive and lymphocytic Pericardial effusions are the leading diagnosis in 35 % of patients in the prospective Marburg registry, followed by malignant effusions in 28 % of cases. Viral genome was assessed in fluid and epi- as well as Pericardial biopsies in 12 %, followed by post-traumatic/iatrogenic effusions in 15 % and purulent/bacterial effusions in only 2 %. Pericardioscopy permits the macroscopic inspection of the pulsating heart and its disease-associated macroscopic alterations. It also permits safe and targeted Biopsy for further investigations of the tissue. Therapy, tailored to the individual etiology, can be selected such as intraPericardial instillation in autoreactive effusions with triamcinolone and with cisplatin or thiotepa in neoplastic effusions. With this approach the recurrence of Pericardial effusion can be avoided effectively. A comprehensive approach to the diagnosis of Pericardial effusions in conjunction with pericardioscopy for targeted tissue sampling is the prerequisite for an etiologically based intraPericardial and systemic treatment, which improves outcome and prognosis.
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pericardioscopy and epi and Pericardial Biopsy a new window to the heart improving etiological diagnoses and permitting targeted intraPericardial therapy
Heart Failure Reviews, 2013Co-Authors: Bernhard Maisch, Arsen D Ristic, Heinz Rupp, Sabine PankuweitAbstract:The etiology of Pericardial effusions remains unresolved in many cases because not the full spectrum of diagnostic methods including cytology, histology, immunohistology and PCR on cardiotropic agents, which are currently available, used in many institutions. After comprehensive clinical workup and use of imaging methods, such as echocardiography and cardiac MRI, pericardiocentesis and epicardial and Pericardial Biopsy were carried out under pericardioscopical control of the Biopsy site. Biopsies and fluid were evaluated by cytological, histological, immunological and molecular (PCR) methods in 259 patients of our tertiary referral center following an identical clinical pathway, diagnostic and therapeutic algorithm in all cases. A standard clinical pathway and the same diagnostic and therapeutic algorithms were used in all cases. When all methods are applied to patients with Pericardial effusions, “idiopathic” Pericardial effusion is no longer a relevant diagnosis. Autoreactive and lymphocytic Pericardial effusions are the leading diagnosis in 35 % of patients in the prospective Marburg registry, followed by malignant effusions in 28 % of cases. Viral genome was assessed in fluid and epi- as well as Pericardial biopsies in 12 %, followed by post-traumatic/iatrogenic effusions in 15 % and purulent/bacterial effusions in only 2 %. Pericardioscopy permits the macroscopic inspection of the pulsating heart and its disease-associated macroscopic alterations. It also permits safe and targeted Biopsy for further investigations of the tissue. Therapy, tailored to the individual etiology, can be selected such as intraPericardial instillation in autoreactive effusions with triamcinolone and with cisplatin or thiotepa in neoplastic effusions. With this approach the recurrence of Pericardial effusion can be avoided effectively. A comprehensive approach to the diagnosis of Pericardial effusions in conjunction with pericardioscopy for targeted tissue sampling is the prerequisite for an etiologically based intraPericardial and systemic treatment, which improves outcome and prognosis.
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interventional pericardiology pericardiocentesis pericardioscopy Pericardial Biopsy balloon pericardiotomy and intraPericardial therapy
2011Co-Authors: Bernhard Maisch, Petar M Seferovic, Arsen D Ristic, Teresa S M TsangAbstract:From the contents: -- Foreword -- Preface -- Acknowledgments -- 1. A Historical Perspective -- 2. Anatomy of the Pericardium Relevant for Pericardial Access, Pericardioscopy, and IntraPericardial Interventions -- 3. Pericardial Effusion and Cardiac Tamponade -- 4. Pericardial Access and Drainage: Standard Techniques -- 5. Alternative Techniques for Pericardiocentesis -- 6. Pericardiocentesis in the Absence of Effusion -- 7. Diagnostic Value of Pericardial Fluid Analyses -- 8. Pericardioscopy: Endoscopic Insight into Pericardial Pathology -- 9. Epicardial and Pericardial Biopsy -- 10. IntraPericardial Treatment of Pericardial Disease -- 11. Percutaneous Balloon Pericardiotomy -- 12. Frontiers and Emerging Procedures -- Index.
Sabine Pankuweit - One of the best experts on this subject based on the ideXlab platform.
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Pericardioscopy and epi- and Pericardial Biopsy—a new window to the heart improving etiological diagnoses and permitting targeted intraPericardial therapy
Heart Failure Reviews, 2013Co-Authors: Bernhard Maisch, Heinz Rupp, Arsen Ristic, Sabine PankuweitAbstract:The etiology of Pericardial effusions remains unresolved in many cases because not the full spectrum of diagnostic methods including cytology, histology, immunohistology and PCR on cardiotropic agents, which are currently available, used in many institutions. After comprehensive clinical workup and use of imaging methods, such as echocardiography and cardiac MRI, pericardiocentesis and epicardial and Pericardial Biopsy were carried out under pericardioscopical control of the Biopsy site. Biopsies and fluid were evaluated by cytological, histological, immunological and molecular (PCR) methods in 259 patients of our tertiary referral center following an identical clinical pathway, diagnostic and therapeutic algorithm in all cases. A standard clinical pathway and the same diagnostic and therapeutic algorithms were used in all cases. When all methods are applied to patients with Pericardial effusions, “idiopathic” Pericardial effusion is no longer a relevant diagnosis. Autoreactive and lymphocytic Pericardial effusions are the leading diagnosis in 35 % of patients in the prospective Marburg registry, followed by malignant effusions in 28 % of cases. Viral genome was assessed in fluid and epi- as well as Pericardial biopsies in 12 %, followed by post-traumatic/iatrogenic effusions in 15 % and purulent/bacterial effusions in only 2 %. Pericardioscopy permits the macroscopic inspection of the pulsating heart and its disease-associated macroscopic alterations. It also permits safe and targeted Biopsy for further investigations of the tissue. Therapy, tailored to the individual etiology, can be selected such as intraPericardial instillation in autoreactive effusions with triamcinolone and with cisplatin or thiotepa in neoplastic effusions. With this approach the recurrence of Pericardial effusion can be avoided effectively. A comprehensive approach to the diagnosis of Pericardial effusions in conjunction with pericardioscopy for targeted tissue sampling is the prerequisite for an etiologically based intraPericardial and systemic treatment, which improves outcome and prognosis.
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pericardioscopy and epi and Pericardial Biopsy a new window to the heart improving etiological diagnoses and permitting targeted intraPericardial therapy
Heart Failure Reviews, 2013Co-Authors: Bernhard Maisch, Arsen D Ristic, Heinz Rupp, Sabine PankuweitAbstract:The etiology of Pericardial effusions remains unresolved in many cases because not the full spectrum of diagnostic methods including cytology, histology, immunohistology and PCR on cardiotropic agents, which are currently available, used in many institutions. After comprehensive clinical workup and use of imaging methods, such as echocardiography and cardiac MRI, pericardiocentesis and epicardial and Pericardial Biopsy were carried out under pericardioscopical control of the Biopsy site. Biopsies and fluid were evaluated by cytological, histological, immunological and molecular (PCR) methods in 259 patients of our tertiary referral center following an identical clinical pathway, diagnostic and therapeutic algorithm in all cases. A standard clinical pathway and the same diagnostic and therapeutic algorithms were used in all cases. When all methods are applied to patients with Pericardial effusions, “idiopathic” Pericardial effusion is no longer a relevant diagnosis. Autoreactive and lymphocytic Pericardial effusions are the leading diagnosis in 35 % of patients in the prospective Marburg registry, followed by malignant effusions in 28 % of cases. Viral genome was assessed in fluid and epi- as well as Pericardial biopsies in 12 %, followed by post-traumatic/iatrogenic effusions in 15 % and purulent/bacterial effusions in only 2 %. Pericardioscopy permits the macroscopic inspection of the pulsating heart and its disease-associated macroscopic alterations. It also permits safe and targeted Biopsy for further investigations of the tissue. Therapy, tailored to the individual etiology, can be selected such as intraPericardial instillation in autoreactive effusions with triamcinolone and with cisplatin or thiotepa in neoplastic effusions. With this approach the recurrence of Pericardial effusion can be avoided effectively. A comprehensive approach to the diagnosis of Pericardial effusions in conjunction with pericardioscopy for targeted tissue sampling is the prerequisite for an etiologically based intraPericardial and systemic treatment, which improves outcome and prognosis.
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IntraPericardial treatment of inflammatory and neoplastic pericarditis guided by pericardioscopy and epicardial Biopsy—results from a pilot study
Clinical Cardiology, 1999Co-Authors: Bernhard Maisch, Sabine Pankuweit, C Brilla, R C Funck, B C Simon, W Grimm, M Herzum, G HufnagelAbstract:: From a registry of 136 patients undergoing pericardiocentesis, 14 patients with autoimmune and 15 patients with neoplastic effusions were selected. All underwent pericardioscopy, epicardial and Pericardial Biopsy with histologic, immunohistologic, and polymerase chain reaction/or in situ hybridization analysis for microbial DNAs and RNA. Pericardioscopy identified neoplastic effusions by the high occurrence of protrusions. Fibrin threads and layers and neovascularization were found in both groups. For identification of the inflammatory and neoplastic process, the combined analysis of the cytology of the effusion and epicardial Biopsy evaluation proved to be most important. Epicardial Biopsy demonstrated a slightly higher sensitivity for identifying neoplastic disorders in the pericardium than cytology alone. Pericardial Biopsy was inconclusive. IntraPericardial administration of 1 g of crystalloid triamcinolone in autoreactive pericarditis prevented recurrence in 13 of the 14 cases after 3 months and in 12 of the 14 cases after 1 year. In neoplastic effusion, intraPericardial administration of 50 mg cis-platin for 24 h prevented recurrence of a hemodynamically relevant effusion after 3 months in all, and after 6-12 months in 14 of 15 patients. Mortality in neoplastic effusion due to noncardiac tumor progression was 47 and 80%, respectively, after 3 and 6 months, as can be expected in endstage neoplastic disease. This pilot study demonstrates that local drug application is feasible, life-saving, and well tolerated by the patients. It opens perspectives for local drug application in other cardiac disorders as well.
Arsen D Ristic - One of the best experts on this subject based on the ideXlab platform.
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pericardioscopy and epi and Pericardial Biopsy a new window to the heart improving etiological diagnoses and permitting targeted intraPericardial therapy
Heart Failure Reviews, 2013Co-Authors: Bernhard Maisch, Arsen D Ristic, Heinz Rupp, Sabine PankuweitAbstract:The etiology of Pericardial effusions remains unresolved in many cases because not the full spectrum of diagnostic methods including cytology, histology, immunohistology and PCR on cardiotropic agents, which are currently available, used in many institutions. After comprehensive clinical workup and use of imaging methods, such as echocardiography and cardiac MRI, pericardiocentesis and epicardial and Pericardial Biopsy were carried out under pericardioscopical control of the Biopsy site. Biopsies and fluid were evaluated by cytological, histological, immunological and molecular (PCR) methods in 259 patients of our tertiary referral center following an identical clinical pathway, diagnostic and therapeutic algorithm in all cases. A standard clinical pathway and the same diagnostic and therapeutic algorithms were used in all cases. When all methods are applied to patients with Pericardial effusions, “idiopathic” Pericardial effusion is no longer a relevant diagnosis. Autoreactive and lymphocytic Pericardial effusions are the leading diagnosis in 35 % of patients in the prospective Marburg registry, followed by malignant effusions in 28 % of cases. Viral genome was assessed in fluid and epi- as well as Pericardial biopsies in 12 %, followed by post-traumatic/iatrogenic effusions in 15 % and purulent/bacterial effusions in only 2 %. Pericardioscopy permits the macroscopic inspection of the pulsating heart and its disease-associated macroscopic alterations. It also permits safe and targeted Biopsy for further investigations of the tissue. Therapy, tailored to the individual etiology, can be selected such as intraPericardial instillation in autoreactive effusions with triamcinolone and with cisplatin or thiotepa in neoplastic effusions. With this approach the recurrence of Pericardial effusion can be avoided effectively. A comprehensive approach to the diagnosis of Pericardial effusions in conjunction with pericardioscopy for targeted tissue sampling is the prerequisite for an etiologically based intraPericardial and systemic treatment, which improves outcome and prognosis.
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interventional pericardiology pericardiocentesis pericardioscopy Pericardial Biopsy balloon pericardiotomy and intraPericardial therapy
2011Co-Authors: Bernhard Maisch, Petar M Seferovic, Arsen D Ristic, Teresa S M TsangAbstract:From the contents: -- Foreword -- Preface -- Acknowledgments -- 1. A Historical Perspective -- 2. Anatomy of the Pericardium Relevant for Pericardial Access, Pericardioscopy, and IntraPericardial Interventions -- 3. Pericardial Effusion and Cardiac Tamponade -- 4. Pericardial Access and Drainage: Standard Techniques -- 5. Alternative Techniques for Pericardiocentesis -- 6. Pericardiocentesis in the Absence of Effusion -- 7. Diagnostic Value of Pericardial Fluid Analyses -- 8. Pericardioscopy: Endoscopic Insight into Pericardial Pathology -- 9. Epicardial and Pericardial Biopsy -- 10. IntraPericardial Treatment of Pericardial Disease -- 11. Percutaneous Balloon Pericardiotomy -- 12. Frontiers and Emerging Procedures -- Index.
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epicardial and Pericardial Biopsy
2011Co-Authors: Bernhard Maisch, Petar M Seferovic, Arsen D Ristic, Teresa S M TsangAbstract:The application of pericardioscopy, targeted Pericardial and epicardial Biopsy as well as the analyses of the respective tissues, has certainly improved our understanding of the pathophysiology of the Pericardial diseases. Most instruments used in the procedure such as endoscope, Biopsy forceps and catheters were originally not designed for the application in the pericardium but for the use in other organs for endoscopic inspection or tissue acquisition. Informed consent of this circumstance from patient is recommended. Further progress has been achieved through the implementation of contemporary pathology (immunocytochemistry, immunohistochemistry) and molecular biology techniques (PCR to cardiotropic microbial agents) in the analysis of Pericardial and epicardial Biopsy samples.
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diagnostic value of Pericardial Biopsy improvement with extensive sampling enabled by pericardioscopy
Circulation, 2003Co-Authors: Petar M Seferovic, Arsen D Ristic, Ružica Maksimovic, Vujadin Tatic, Miodrag Ostojic, Vladimir KanjuhAbstract:Background— The clinical significance of Pericardial Biopsy is controversial. The aim of this study was to assess the feasibility and diagnostic value of 3 approaches to Pericardial Biopsy: fluoros...
Larry J. Goodman - One of the best experts on this subject based on the ideXlab platform.
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Purulent pericarditis
Current Treatment Options in Cardiovascular Medicine, 2000Co-Authors: Larry J. GoodmanAbstract:Purulent pericarditis represents a subset of Pericardial disease usually due to a non-viral infectious agent. The presentation is often acute, with rapid progression to tam-ponade unless a drainage procedure is performed. Although several infectious agents account for the majority of infections, the differential diagnosis is broad. Often, patients with more exotic infectious causes have risk factors for these agents that can be identified by careful history-taking. Distinguishing a bacteremic source from infec-tion acquired by contiguous spread is particularly important. Although most infections spread contiguously are a complication of recent surgery or nearby pneumonia and are, therefore, apparent to the physician, others may be less obvious. For example, head and neck space infections may track to the retropharyngeal space and, from there, posteriorly to the so-called "danger" space, which connects inferiorly to the mediasti-num and the pericardium. Failing to identify this source of tracking infection may lead to inadequate drainage as well as inappropriate empiric antibiotic therapy. In acute cases, needle drainage with appropriate staining and culturing of the fluid is adequate for diagnosis and initial management of the complications of fluid collection in the closed space of the Pericardial sac. Pericardial Biopsy may be the sole method of iden-tifying an etiologic agent, particularly in chronic cases in which granulomatous dis-ease is more commonly seen. In select cases, Pericardial window or pericardiectomy procedures are needed to limit complications of reaccumulation of fluid.
Heinz Rupp - One of the best experts on this subject based on the ideXlab platform.
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Pericardioscopy and epi- and Pericardial Biopsy—a new window to the heart improving etiological diagnoses and permitting targeted intraPericardial therapy
Heart Failure Reviews, 2013Co-Authors: Bernhard Maisch, Heinz Rupp, Arsen Ristic, Sabine PankuweitAbstract:The etiology of Pericardial effusions remains unresolved in many cases because not the full spectrum of diagnostic methods including cytology, histology, immunohistology and PCR on cardiotropic agents, which are currently available, used in many institutions. After comprehensive clinical workup and use of imaging methods, such as echocardiography and cardiac MRI, pericardiocentesis and epicardial and Pericardial Biopsy were carried out under pericardioscopical control of the Biopsy site. Biopsies and fluid were evaluated by cytological, histological, immunological and molecular (PCR) methods in 259 patients of our tertiary referral center following an identical clinical pathway, diagnostic and therapeutic algorithm in all cases. A standard clinical pathway and the same diagnostic and therapeutic algorithms were used in all cases. When all methods are applied to patients with Pericardial effusions, “idiopathic” Pericardial effusion is no longer a relevant diagnosis. Autoreactive and lymphocytic Pericardial effusions are the leading diagnosis in 35 % of patients in the prospective Marburg registry, followed by malignant effusions in 28 % of cases. Viral genome was assessed in fluid and epi- as well as Pericardial biopsies in 12 %, followed by post-traumatic/iatrogenic effusions in 15 % and purulent/bacterial effusions in only 2 %. Pericardioscopy permits the macroscopic inspection of the pulsating heart and its disease-associated macroscopic alterations. It also permits safe and targeted Biopsy for further investigations of the tissue. Therapy, tailored to the individual etiology, can be selected such as intraPericardial instillation in autoreactive effusions with triamcinolone and with cisplatin or thiotepa in neoplastic effusions. With this approach the recurrence of Pericardial effusion can be avoided effectively. A comprehensive approach to the diagnosis of Pericardial effusions in conjunction with pericardioscopy for targeted tissue sampling is the prerequisite for an etiologically based intraPericardial and systemic treatment, which improves outcome and prognosis.
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pericardioscopy and epi and Pericardial Biopsy a new window to the heart improving etiological diagnoses and permitting targeted intraPericardial therapy
Heart Failure Reviews, 2013Co-Authors: Bernhard Maisch, Arsen D Ristic, Heinz Rupp, Sabine PankuweitAbstract:The etiology of Pericardial effusions remains unresolved in many cases because not the full spectrum of diagnostic methods including cytology, histology, immunohistology and PCR on cardiotropic agents, which are currently available, used in many institutions. After comprehensive clinical workup and use of imaging methods, such as echocardiography and cardiac MRI, pericardiocentesis and epicardial and Pericardial Biopsy were carried out under pericardioscopical control of the Biopsy site. Biopsies and fluid were evaluated by cytological, histological, immunological and molecular (PCR) methods in 259 patients of our tertiary referral center following an identical clinical pathway, diagnostic and therapeutic algorithm in all cases. A standard clinical pathway and the same diagnostic and therapeutic algorithms were used in all cases. When all methods are applied to patients with Pericardial effusions, “idiopathic” Pericardial effusion is no longer a relevant diagnosis. Autoreactive and lymphocytic Pericardial effusions are the leading diagnosis in 35 % of patients in the prospective Marburg registry, followed by malignant effusions in 28 % of cases. Viral genome was assessed in fluid and epi- as well as Pericardial biopsies in 12 %, followed by post-traumatic/iatrogenic effusions in 15 % and purulent/bacterial effusions in only 2 %. Pericardioscopy permits the macroscopic inspection of the pulsating heart and its disease-associated macroscopic alterations. It also permits safe and targeted Biopsy for further investigations of the tissue. Therapy, tailored to the individual etiology, can be selected such as intraPericardial instillation in autoreactive effusions with triamcinolone and with cisplatin or thiotepa in neoplastic effusions. With this approach the recurrence of Pericardial effusion can be avoided effectively. A comprehensive approach to the diagnosis of Pericardial effusions in conjunction with pericardioscopy for targeted tissue sampling is the prerequisite for an etiologically based intraPericardial and systemic treatment, which improves outcome and prognosis.