Mesothelioma is a rare but aggressive type of cancer caused by asbestos exposure. Asbestos is a natural mineral that can be woven and mixed into cement to be used in industries like construction, shipbuilding and manufacturing. Due to its heat resistance, tensile strength, and insulating properties, asbestos were used for about 100 years before being proven toxic. If untouched, asbestos can be harmless, but when the material is disturbed, asbestos fibers are released into the air. Asbestos fibers may be inhaled or swollen and the body cannot properly expel them.

The fibers become housed in the mesothelial cells, which compose a membrane known as the mesothelium that covers some organs. When it occurs in the lining of the lungs, the disease is named pleural mesothelioma, while peritoneal mesothelioma refers to tumors in the abdomen lining, pericardial mesothelioma in the heart and testicular mesothelioma in the tunica vaginalis testis. There is currently no cure for mesothelioma, but chemotherapy and/or radiation therapy can help ease the symptoms. Surgeries such as pericardiocentesis are also treatment options.

Pericardiocentesis as a Surgical Procedure

A pericardiocentesis is a procedure during which a needle is used to remove fluid that accumulates in the pericardial sac, the tissue around the heart. While a surgery so near the heart has numerous risks, it may be recommended for patients with pericardial mesothelioma or pleural mesothelioma that spread to the heart. Before the surgery, a catheter is placed in the patient’s arm to administer fluids and medication and an anesthesia is applied to the area so that the patient doesn’t feel. Then, the physician inserts a needle and position it into the tissue surrounding the heart.

An echocardiography is performed to increase visibility, while an electrocardiogram and x-rays may be used to position the needle. As the needle is positioned, the physician substitutes it by a catheter and drain the fluid into containers, a process that can take hours. A pericardiocentesis may be used either as a diagnostic method, after which the fluid is analyzed, or as treatment to decrease the fluid. In the case of reoccurrence or if the physician is unable to drain the fluid with this less invasive procedure, drainage during an open surgery may be needed.

Benefits and Risks of a Pericardiocentesis

Fluid around the heart, a symptom of mesothelioma also known as pericardial effusion, causes stress and pressure that prevents the heart from properly functioning. A pericardiocentesis can help reduce this problem, decreasing problems that may occur as consequence of pericardial effusion, which include low blood and oxygen circulation and the risk of heart failure. However, if the tumors are not removed, fluid may accumulate again in the pericardial sac. Despite the fact that pericardiocentesis is a minimally invasive procedure, there are risks just like in any other surgical procedure.

According to the National Institutes of Health (NIH), complications occur in four to 40% of the cases and include dysrhythmias, irregular heartbeats (arrhythmias), coronary artery puncture or aneurysm, left internal mammary artery puncture or aneurysm, hemothorax, pneumothorax, pneumopericardium, hepatic injury, false-negative aspiration or clotted blood in the pericardium, false-positive aspiration or intracardiac aspiration, reaccumulation of pericardial fluid, bleeding, collapsed lung, infection (pericarditis), puncture of the heart muscle, coronary artery, lung, liver, or stomach, pneumopericardium (air in the pericardial sac) and heart attack.