The letter by Anthony Vaz, MD, outlines a method of directly visualizing the pericardium. It does indeed eliminate blind-needle incision, allow excellent positioning of the catheter, possibly decrease the chances of traumatic hemorrhagic effusion, and allow easy identification of loculated and adhesive compartment formation.
I do not know whether to agree to the procedure, as it adds a surgical technique that is far from simple and would tend to cause internists some delay in their deciding to proceed with the catheter placement and instillation of local steroid. In our hands, the percutaneous placement of the catheter has only minimal morbidity, and I would continue to use that method. I think Dr Vaz's technique should be evaluated in each case, however, and should certainly be used where there is suspicion of loculated and adhesive compartment formation.
Dr Vaz does not tell us how he secures the catheter within the