Pericardiocentesis under echocardiographic guidance.

We thank Drs Tsang and Seward for their interesting comments. The Mayo Clinic’s important experience in echoguided pericardiocentesis was cited in our paper. However, the approach we described is technically different. In Europe, the Marfan’s approach, or subxiphoid puncture proposed by Marfan, is routinely used in cardiac tamponade, in which a swinging heart is frequently present. The most common approach for pericardiocentesis is left xypho-costal, with the needle aimed towards the left shoulder. Rare vascular complications, such as puncture of the left mammary artery, have been described. The Mayo Clinic group advocates a puncture site where the pericardial fluid is closest to the transducer, with the needle track avoiding the heart or any underlying vital structure. The apical approach is Pericardiocentesis Under Echocardiographic Guidance