Transcardiac pericardiocentesis: an emergency life-saving technique for cardiac tamponade.

Life-threatening cardiac tamponade is one of the most serious complications of catheter-based cardiac procedures. Although most cases can be effectively treated by percutaneous pericardiocentesis, urgent surgical drainage is required in unsuccessful cases. Rarely, in collapsed patients, the delay for surgery, however minimal, may be fatal. We describe a technique whereby life-saving pericardial drainage was rapidly achieved via a novel transcardiac approach, using the transseptal puncture kit, after failure of conventional pericardiocentesis in a patient with procedure-related acute tamponade who rapidly deteriorated and developed cardiorespiratory arrest within a few minutes. Although surgical repair for the perforation had to be performed subsequently, the patient survived without sequelae. This transcardiac approach may be an important and potentially life-saving adjunctive technique after failure of conventional pericardiocentesis in rapidly deteriorating or extremely unstable patients.