Having a Percutaneous Balloon Pericardiotomy

Percutaneous balloon pericardiotomy (PBP) is a procedure to drain extra fluid from the sac around your heart (pericardium). It’s done with a long thin tube (catheter) that has a small balloon attached. A small hole is made in the sac, and the balloon inflated to make the hole bigger. Fluid is then drained out through the tube.

What to tell your healthcare provider

Before your procedure, tell your healthcare provider:

• What medicines you take. This includes over-the-counter medicines, such as ibuprofen. It also includes all prescriptions, vitamins, herbs, and other supplements. You may need to stop taking some medicines before the procedure, such as blood thinners and aspirin.

• If you smoke. You may need to stop before your surgery. Smoking can delay healing. Talk with your healthcare provider if you need help to stop smoking.

• If you’ve had recent changes in your health. This includes an infection or fever.

• If you are sensitive or allergic to anything. This includes medicines, latex, tape, and anesthetic medicines.

• If you are pregnant. Also tell your healthcare provider if you think you may be pregnant.

Getting ready for your procedure

Make sure to:

• Ask a family member or friend to take you home from the hospital

• Make plans for some help at home while you recover

• Follow all other instructions from your healthcare provider

• Read the consent form and ask questions if something is not clear

• Follow any directions you are given for not eating or drinking before surgery.

Tests before your procedure

Before your surgery, you may need tests, such as:

• Chest X-ray

• Electrocardiogram (ECG), to check the heart rhythm

• Blood tests, to check your general health

• Echocardiogram (ultrasound), to look at blood flow through your heart and view the fluid around your heart

• CT scan or MRI scan, if the healthcare provider needs more information about your heart

On the day of your procedure

Your procedure will be done by a cardiologist. They will work with a team of specialized nurses. The procedure can be done in several ways. It will likely be done in a heart catheterization (cath) lab. Ask your healthcare provider about the details of your procedure. It may take several hours. In general, you can expect the following:

• You will be awake. An IV will be put in your hand or arm. You will likely be given medicine to make you sleepy.

• A healthcare provider will watch your heart rate, blood pressure, and other vital signs during the procedure.

• An echocardiogram will be done to look at your heart and pericardium.

• A local anesthetic will be given at the needle insertion site, below your breastbone.

• The healthcare provider will put the needle through the skin. They will use an echocardiogram or X-ray imaging (fluoroscopy) to help guide the needle to the sac.

• Once the needle is in the correct area, the healthcare provider will remove it and replace it with a catheter. This catheter has a balloon at its tip.

• The healthcare provider will carefully inflate the balloon over several minutes. This may be a little painful, but you can have pain medicine. The procedure may be repeated with 2 balloons to create 2 windows in the pericardium.

• The healthcare provider will deflate the balloons and remove the catheters. They may replace them with another set of catheters. These will stay in place for a while as the fluid around the heart drains.

• When enough fluid has drained, the healthcare provider will remove the catheters. When those catheters are removed, any extra fluid that may occur again can drain into the larger space around the lungs (pleural cavity). The body then reabsorbs the fluid.

• Pressure will be applied over the catheter insertion site to prevent bleeding.

After your procedure

After the procedure, you will spend some time in a recovery room. You may be sleepy for a while. Your healthcare team will watch your heart rate, breathing, and other vital signs. You will likely be in the hospital for one or more days. You may have a chest X-ray and an echocardiogram. These are done to check the hole in the pericardium and check for fluid in the lungs.

Risks of the procedure

• Bleeding

• Puncturing the heart

• Inability to remove the fluid

• Entering the space around the lung causing a collapsed lung

• Puncturing the lung

• Irregular heart rhythm

• Death

Recovering at home

Follow all the directions your healthcare provider gives you for medicines, exercise, diet, and wound care. You should be able to go back to your normal activities soon. Don't do vigorous exercise until your healthcare provider says you are ready.

Follow-up care

Make sure you keep all of your follow-up appointments.

When to call your healthcare provider

Call your healthcare provider right away if any of the following occur:

• Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider

• More fluid leaking from the needle site

• Swelling of the legs or abdomen (belly)

• Persistent nausea or vomiting

Call 911

Call 911 if any of the following occur:

• Chest pain that gets worse, or unusual chest pain

• Difficulty breathing that is new or gets worse

• Fainting or lightheadedness

• Any other severe symptoms