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        "titulo" => "Pericardiocentese guiada por tomografia computorizada &#8211; experi&#234;ncia num centro"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Use of computed tomography in pericardiocentesis&#46; &#40;a&#41; Characterization and assessment of effusion&#59; &#40;b&#41; determination of best entry point and needle orientation&#59; &#40;c&#41; control of needle progression and relation with surrounding structures&#59; &#40;d&#41; pigtail positioning&#59; &#40;e&#41; final result and control of evolution&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">There are many clinical scenarios in which pericardial effusion may develop&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">1</span></a> It can be caused by bleeding into the pericardial space or other fluid accumulation&#46; Etiology may be inflammatory&#47;infectious&#44; traumatic&#44; post-operative&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">2</span></a> or related to cancer or other chronic conditions such as uremia&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">3</span></a> Its main adverse consequence is its potential impact on cardiac hemodynamics&#44; which will depend mainly on the volume and rate of development of the effusion&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">4</span></a> Clinical presentation of a significant pericardial effusion usually includes lightheadedness&#44; chest discomfort&#44; dyspnea&#44; anxiety&#44; tachycardia and hypotension&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">5</span></a> Echocardiography is the imaging modality of choice for diagnosis and for estimating hemodynamic impairment&#44; through assessment of right heart chamber dynamics&#46; Other diagnostic tools may be required for etiologic investigation or anatomical definition&#44; such as computed tomography &#40;CT&#41; and cardiovascular magnetic resonance&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">6&#44;7</span></a> Pericardiocentesis is usually indicated when hemodynamic impact is significant or when needed for etiologic diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">8&#8211;10</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">As it is an invasive procedure&#44; there is always a significant risk of complications&#44; which may be reduced with enhanced control in needle positioning&#44; in order to avoid unintended puncture of structures&#46; Electrocardiogram-guided<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a> and fluoroscopy-guided<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">12</span></a> techniques have been described&#46; Guidance in recent years has been mainly through echocardiography<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">13&#8211;16</span></a> &#40;offline or real-time&#41; because of its improved safety over a blind approach&#46; CT-guided pericardiocentesis &#40;CTP&#41; is also an option in centers with access to and expertise in this technique&#44;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">17&#44;18</span></a> with the advantage of detailed three-dimensional imaging&#44; which enables fine needle positioning&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">This work reports on our experience with CTP&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">All procedures were performed by experienced cardiologists or cardiac surgeons&#44; using a Seldinger technique according to previously described protocols&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">17</span></a> CT guidance was obtained using a 64-slice scanner &#40;Siemens SOMATOM Sensation&#44; Erlangen&#44; Germany&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; Patients provided informed consent&#46; During the procedure they were asked to breathe steadily and abstain from moving or breathing deeply&#46; Local anesthesia with subcutaneous lidocaine was performed in every patient and light sedation &#40;diazepam 5 mg orally&#41; was administered when needed&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Images of the whole thorax were acquired before the procedure and were analyzed with dedicated software &#40;Siemens Syngo Viewer<span class="elsevierStyleSup">&#174;</span>&#41;&#46; Parameters used by protocol were&#58; tube voltage 100 kV&#44; tube current 110 mAs&#44; reconstruction with 0&#46;75 mm sections&#44; overlap 0&#46;5 mm&#46; Typical window width&#47;level used during the procedure was 700&#47;80&#46; The best entry point and needle orientation were determined &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; We used an 18 gauge needle from the PeriVac&#8482; kit &#40;Boston Scientific<span class="elsevierStyleSup">&#174;</span>&#41;&#46; After superficial needle insertion&#44; new images of the area of interest were acquired&#46; Needle orientation was corrected as needed and the needle was advanced under aspiration&#46; New images were acquired as needed&#46; When the pericardial space was reached&#44; a drain &#40;8&#46;3F pigtail catheter from the kit&#41; was inserted through a guidewire &#40;J-tipped 0&#46;035&#8243;&#215;80 cm&#41; and final images were acquired&#46; When in doubt &#40;due to limited pericardial width at the puncture site&#41; a small amount of contrast &#40;by protocol 5 ml diluted in 10 ml of saline&#41; was injected to confirm an intra-pericardial needle position before dilation and drain insertion &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Data were stored in a dedicated computer database&#46; Statistical analysis was performed using IBM SPSS Statistics 21 &#40;2012&#41;&#46; Values are presented as mean &#177; standard deviation or median &#40;interquartile range&#41; as appropriate&#46; Normality of the sample distribution was tested using the Shapiro-Wilk test&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">Between August 2008 and February 2014&#44; 49 patients were referred for CTP&#44; which was performed in 46 patients&#46; In three patients the effusion was considered unsuitable for pericardiocentesis &#40;shallow or posterior location&#41;&#46; Patient characteristics are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">A total of 51 procedures were reported&#46; Five patients underwent repeat procedures due to recurrence of significant effusion &#40;three post-surgical&#44; two of unknown etiology&#41;&#46; The purpose of the procedure was mainly diagnostic in only two cases&#46; The most common etiologies of pericardial effusion were post-surgical &#40;48&#37;&#44; 22 cases&#41; and neoplasm-related &#40;17&#37;&#44; eight cases&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">International normalized ratio &#40;INR&#41; was measured in 33 procedures&#44; including in all patients under oral anticoagulation&#59; there were five patients with INR &#62;2&#44; with a maximum of 6&#46;88&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Procedural data are summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The procedure had a median duration of 65 &#40;50-80&#41; min and median total effective radiation exposure was 3&#46;3 &#40;2&#46;38&#8211;5&#46;17&#41; mSv&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The volume of drained fluid was variable&#44; with a mean of 781&#177;452&#46;4 ml&#46; Drainage was considered completely successful in 46 &#40;90&#37;&#41; of cases&#46; It was considered only partially successful in two cases &#40;4&#37;&#41;&#44; both due to persistent fluid accumulation in a posterior location&#59; one of them underwent successful surgical drainage&#44; the other needed no further intervention&#46; CTP was considered unsuccessful in three cases &#40;6&#37;&#41;&#44; probably due to highly septated&#47;organized effusions&#59; one had been attempted for diagnostic purposes&#44; the other two underwent successful surgical drainage&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">There were no significant immediate adverse events related to the procedure&#44; even in patients with INR &#62;2&#46; There was&#44; however&#44; one late complication&#44; with development of pyopericardium&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The results are integrated with previously published data in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">The main finding of our study is that CT is an effective and safe technique to guide pericardiocentesis&#44; which is an invasive and potentially dangerous procedure reserved for specific clinical scenarios&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In an era of multimodality imaging in cardiology&#44; blind &#40;or even ECG-guided or fluoroscopy-guided&#41; pericardiocentesis is becoming obsolete&#44; and is not recommendable&#44; except in life-saving situations&#46; Other imaging techniques may have some advantages for needle guidance&#46; Echocardiography&#44; above all&#44; is a valuable and practical option&#44; and is probably best when using a probe-mounted needle&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">19</span></a> It provides continuous real-time imaging&#44; and is widely available and probably logistically simpler and less time-consuming than CT&#46; It has&#44; however&#44; the disadvantage of not infrequent poor acoustic windows and less reliable needle tip visualization and orientation&#46; CT allows the physician to better evaluate needle direction&#44; tip positioning and relation with surrounding structures&#46; The main limitation of CT is probably its availability&#44; which is not as ubiquitous as echocardiography but is increasing&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">CTP has previously been described as safe and effective&#46; This series illustrates our good experience with this technique&#46; It encompasses a reasonable-sized sample of 46 patients&#44; almost half of them post-surgical&#44; with a high procedural success rate &#40;90&#37; complete drainage&#44; 4&#37; incomplete and 6&#37; unsuccessful&#41;&#44; and no major immediate complications recorded&#46; There was one case of pyopericardium&#44; which developed several days after the procedure&#44; performed for a significant effusion in the likely context of Dressler syndrome&#46; No immediate complications were observed and the patient was transferred back to the referring hospital&#46; He was readmitted seven days after the procedure due to recurrence of the effusion and pyopericardium was confirmed after surgical drainage&#46; The patient eventually died 52 days after the index procedure&#46; This was assumed to be a late complication of pericardiocentesis&#46; Infectious complications secondary to pericardiocentesis appear to be rare but have been described before with other imaging techniques<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">14&#44;20</span></a> and are probably related to the drainage technique&#44; rather than the imaging modality&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">These findings of high success and low complication rates are in line with the literature&#46; Duvernoy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a> reported the first series of 10 patients in 1996&#44; all with successful drainage and no major complications&#46; Bruning et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">22</span></a> described a series of 11 patients with effusions not drainable under sonographic surveillance&#44; all successful&#44; and one complication &#40;an epicardial laceration requiring surgery&#41;&#46; Klein et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a> published a single-center experience of 319 procedures with a success rate of 98&#46;4&#37; and a major complication rate of 0&#46;3&#37;&#46; In 2008 Palmer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">23</span></a> presented a series of 39 procedures in post-surgical patients&#44; all of them successful&#44; without significant complications&#44; and CTP was shown to have the additional benefit of reducing costs compared to surgical drainage&#46; Eichler et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">17</span></a> published a series of 20 patients &#40;85&#37; post-surgical&#41;&#59; all of them were successful and no major complications were reported&#46; Ceviz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">24</span></a> recently published a series of 30 patients&#44; successful in 29&#44; with one major complication &#40;hemopericardium due to epicardial injury&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Complications are more likely to occur with increasing numbers of procedures&#44; and are never completely avoidable in invasive procedures&#46; Pericardiocentesis is an invasive procedure frequently performed in frail patients&#44; and is thus associated with a non-negligible risk of complications&#46; The decision to perform it is therefore classically conservative&#44; given the potential benefit&#47;risk ratio&#46; CT guidance is proving to be an important tool in improving that ratio due to its ability to guide the procedure and increase safety&#46; Holistic&#44; informed&#44; and whenever possible evidence-based clinical judgment is essential for every decision in medicine&#46; Increasing the safety of an invasive procedure does not mean it should be performed in more patients who have smaller effusions&#46; But it certainly means it can be performed in an urgent setting&#44; before there is frank hemodynamic instability&#44; which is preferable to an emergent setting&#44; with the patient in cardiac tamponade&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In line with the published literature&#44; this work provides evidence for the feasibility&#44; advantages and disadvantages of CTP&#44; when using a standardized protocol&#44; performed by experienced physicians and in specific clinical settings&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Limitations</span><p id="par0105" class="elsevierStylePara elsevierViewall">This is a retrospective descriptive analysis of the experience of a single center with clinical expertise in cardiac MDCT&#46; Additionally&#44; this is a tertiary center with a locally available catheterization laboratory and cardiac surgery facilities&#46; Therefore&#44; our data reflect a specific hospital population that may preclude generalization of the findings&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0110" class="elsevierStylePara elsevierViewall">In our experience CTP is an effective and safe option in patients with clinical indications for pericardial fluid drainage&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical disclosures</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Protection of human and animal subjects</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Confidentiality of data</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Right to privacy and informed consent</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pericardial effusion is a common complication in clinical situations such as cardiothoracic surgery and cancer&#44; in which pericardiocentesis may be essential&#46; Pericardiocentesis can be guided by different imaging techniques&#44; most commonly echocardiography&#46; Computed tomography &#40;CT&#41; has significant advantages but there is still little evidence supporting its use in this context&#46; In this work we describe our experience with CT-guided pericardiocentesis &#40;CTP&#41; in a single center&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patients referred for CTP between August 2008 and February 2014 were retrospectively analyzed&#46; We assessed demographics&#44; etiology of the effusion&#44; international normalized ratio during the procedure&#44; radiation doses&#44; success rate and complications&#46; Results were compared with those in the literature&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">During this period&#44; 51 procedures were performed&#44; in 46 patients&#46; Five patients underwent a repeat procedure due to recurrence of effusion&#46; The most common etiologies were post-surgical &#40;48&#37;&#44; 22 patients&#41; and neoplasm-related &#40;17&#37;&#44; eight patients&#41;&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Drainage was considered completely successful in 46 cases &#40;90&#37;&#41;&#44; partially successful in two &#40;4&#37;&#41; and unsuccessful in three &#40;6&#37;&#41;&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The median duration of the procedure was 65 min &#40;interquartile range 50&#8211;80&#41; and median effective radiation exposure was 3&#46;3 mSv &#40;interquartile range 2&#46;4&#8211;5&#46;2 mSv&#41;&#46; There were no significant adverse events related to the procedure&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">By providing high-definition three-dimensional images&#44; CTP enables accurate positioning of pericardiocentesis material&#46; It was shown to be an accurate&#44; effective and safe method&#44; in agreement with previous findings&#46; CTP should be considered a good option in centers with CT facilities&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">O derrame peric&#225;rdico &#233; uma complica&#231;&#227;o tem&#237;vel em v&#225;rias situa&#231;&#245;es cl&#237;nicas&#44; em que a pericardiocentese pode ter um papel fundamental&#46; Esta pode ser guiada por v&#225;rios m&#233;todos de imagem&#44; sobretudo ecocardiografia&#46; A tomografia computorizada &#40;TC&#41; tem v&#225;rias vantagens&#44; mas o seu uso tem ainda fraca evid&#234;ncia cl&#237;nica&#46; Neste trabalho &#233; reportada a experi&#234;ncia de um centro em pericardiocentese guiada por TC &#40;P-TC&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Foram analisados retrospetivamente pacientes &#40;pts&#41; referenciados para P-TC durante o per&#237;odo de agosto de 2008 a fevereiro de 2014&#46; Foi avaliada a demografia&#44; etiologia do derrame&#44; INR&#44; radia&#231;&#227;o&#44; sucesso e complica&#231;&#245;es&#44; sendo os resultados comparados aos publicados na literatura&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Durante este per&#237;odo&#44; foram realizados 51 procedimentos em 46 doentes&#46; Cinco doentes repetiram o procedimento devido a recorr&#234;ncia do derrame&#46; A idade m&#233;dia foi de 63&#177;13&#44;8 anos&#46; As etiologias mais frequentes foram p&#243;s-cir&#250;rgica &#40;48&#37;&#44; 22 pts&#41; e neoplasia &#40;17&#37;&#44; oito pts&#41;&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">A drenagem foi considerada completa em 90&#37; &#40;46&#41; dos casos&#44; parcial em 4&#37; &#40;dois&#41; e ineficaz em 6&#37; &#40;tr&#234;s&#41;&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">O procedimento teve uma dura&#231;&#227;o mediana de 65 minutos &#40;Q1-Q3 50-80 minutos&#41; e a exposi&#231;&#227;o de radia&#231;&#227;o foi de 3&#44;3 mSv &#40;Q1-Q3 2&#44;4-5&#44;2 mSv&#41;&#46; N&#227;o foram detetadas complica&#231;&#245;es imediatas relevantes&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Ao providenciar imagens de alta defini&#231;&#227;o em tr&#234;s dimens&#245;es&#44; a P-TC permite o posicionamento preciso do material de pericardiocentese&#44; tendo demonstrado nesta s&#233;rie ser um m&#233;todo eficaz e seguro&#44; indo ao encontro da informa&#231;&#227;o previamente publicada&#46; A P-TC deve&#44; por isso&#44; ser considerada uma boa op&#231;&#227;o em centros com disponibilidade de TC&#46;</p></span>"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#245;es"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Use of computed tomography in pericardiocentesis&#46; &#40;a&#41; Characterization and assessment of effusion&#59; &#40;b&#41; determination of best entry point and needle orientation&#59; &#40;c&#41; control of needle progression and relation with surrounding structures&#59; &#40;d&#41; pigtail positioning&#59; &#40;e&#41; final result and control of evolution&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Example of a case in which intrapericardial contrast was used&#46; &#40;a&#41; Coronal view&#59; &#40;b&#41; sagittal view&#59; &#40;c&#41; axial view&#46;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">ASD&#58; atrial septal defect&#59; BMI&#58; body mass index&#59; CABG&#58; coronary artery bypass grafting&#59; EPS&#58; electrophysiological study&#59; INR&#58; international normalized ratio&#59; MI&#58; myocardial infarction&#59; VSD&#58; ventricular septal defect&#46;</p>"
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#177;13&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Gender</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Male</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;45&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">BMI &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleBold">2</span></span><span class="elsevierStyleBold">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#177;4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Etiology of effusion</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Post-surgical</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;48&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Valvular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>CABG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Valvular &#43; CABG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>ASD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Other surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Neoplasm</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Ovary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Neuroendocrine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Breast&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Stomach&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Heart failure</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Autoimmune</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Other</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Free wall rupture after MI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Acute pericarditis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Complication of EPS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Unknown</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Purpose of procedure</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diagnostic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Therapeutic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49 &#40;96&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Success</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;94&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Complete&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46 &#40;90&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Incomplete&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Insuccess</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Effective radiation &#40;mSv&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;3 &#40;IQR 2&#46;4-5&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Drained volume &#40;ml&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">781&#177;452&#46;4 &#40;10&#8211;2000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Fluid type</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Clear yellow&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Serosanguineous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sanguineous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Data not available&#47;unknown&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Contrast use &#40;no&#46; of procedures&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Repeat procedures &#40;no&#46; of procedures&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Time between procedures &#40;median in days&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;7&#8211;111&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Authors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Year of publication&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">No&#46; of procedures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Success&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Complications</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Minor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Major&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duvernoy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1996&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bruning et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Klein et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">319&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">314 &#40;98&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;6&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Palmer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">23</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Eichler et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ceviz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">24</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;97&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Current study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48 &#40;94&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Total&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">480&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">471 &#40;98&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;0&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Published series&#46;</p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:24 [
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              "identificador" => "bib0125"
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              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Clinical clues to the causes of large pericardial effusions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Sagrist&#224;-Sauleda"
                            1 => "J&#46; Merc&#233;"
                            2 => "G&#46; Permanyer-Miralda"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "2000"
                        "volumen" => "109"
                        "paginaInicial" => "95"
                        "paginaFinal" => "101"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10967149"
                            "web" => "Medline"
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            1 => array:3 [
              "identificador" => "bib0130"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postoperative cardiac tamponade in the modern surgical era"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;T&#46; Kuvin"
                            1 => "N&#46;A&#46; Harati"
                            2 => "N&#46;G&#46; Pandian"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2002"
                        "volumen" => "74"
                        "paginaInicial" => "1148"
                        "paginaFinal" => "1153"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12400760"
                            "web" => "Medline"
                          ]
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            2 => array:3 [
              "identificador" => "bib0135"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of pericardial effusion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Imazio"
                            1 => "Y&#46; Adler"
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                        ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehs372"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2013"
                        "volumen" => "34"
                        "paginaInicial" => "1186"
                        "paginaFinal" => "1197"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23125278"
                            "web" => "Medline"
                          ]
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            3 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
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Original Article
Computed tomography-guided pericardiocentesis – A single-center experience
Pericardiocentese guiada por tomografia computorizada – experiência num centro
David Nevesa,b,
Autor para correspondência
dcneves25@hotmail.com

Corresponding author.
, Guida Silvab, Gustavo Moraisb, Nuno Ferreirab, Mónica Carvalhob, Vasco Gama Ribeirob, Nuno Bettencourtb
a Serviço de Cardiologia, Hospital do Espírito Santo, Évora, Portugal
b Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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        "titulo" => "Pericardiocentese guiada por tomografia computorizada &#8211; experi&#234;ncia num centro"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Use of computed tomography in pericardiocentesis&#46; &#40;a&#41; Characterization and assessment of effusion&#59; &#40;b&#41; determination of best entry point and needle orientation&#59; &#40;c&#41; control of needle progression and relation with surrounding structures&#59; &#40;d&#41; pigtail positioning&#59; &#40;e&#41; final result and control of evolution&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">There are many clinical scenarios in which pericardial effusion may develop&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">1</span></a> It can be caused by bleeding into the pericardial space or other fluid accumulation&#46; Etiology may be inflammatory&#47;infectious&#44; traumatic&#44; post-operative&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">2</span></a> or related to cancer or other chronic conditions such as uremia&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">3</span></a> Its main adverse consequence is its potential impact on cardiac hemodynamics&#44; which will depend mainly on the volume and rate of development of the effusion&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">4</span></a> Clinical presentation of a significant pericardial effusion usually includes lightheadedness&#44; chest discomfort&#44; dyspnea&#44; anxiety&#44; tachycardia and hypotension&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">5</span></a> Echocardiography is the imaging modality of choice for diagnosis and for estimating hemodynamic impairment&#44; through assessment of right heart chamber dynamics&#46; Other diagnostic tools may be required for etiologic investigation or anatomical definition&#44; such as computed tomography &#40;CT&#41; and cardiovascular magnetic resonance&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">6&#44;7</span></a> Pericardiocentesis is usually indicated when hemodynamic impact is significant or when needed for etiologic diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">8&#8211;10</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">As it is an invasive procedure&#44; there is always a significant risk of complications&#44; which may be reduced with enhanced control in needle positioning&#44; in order to avoid unintended puncture of structures&#46; Electrocardiogram-guided<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a> and fluoroscopy-guided<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">12</span></a> techniques have been described&#46; Guidance in recent years has been mainly through echocardiography<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">13&#8211;16</span></a> &#40;offline or real-time&#41; because of its improved safety over a blind approach&#46; CT-guided pericardiocentesis &#40;CTP&#41; is also an option in centers with access to and expertise in this technique&#44;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">17&#44;18</span></a> with the advantage of detailed three-dimensional imaging&#44; which enables fine needle positioning&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">This work reports on our experience with CTP&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">All procedures were performed by experienced cardiologists or cardiac surgeons&#44; using a Seldinger technique according to previously described protocols&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">17</span></a> CT guidance was obtained using a 64-slice scanner &#40;Siemens SOMATOM Sensation&#44; Erlangen&#44; Germany&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; Patients provided informed consent&#46; During the procedure they were asked to breathe steadily and abstain from moving or breathing deeply&#46; Local anesthesia with subcutaneous lidocaine was performed in every patient and light sedation &#40;diazepam 5 mg orally&#41; was administered when needed&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Images of the whole thorax were acquired before the procedure and were analyzed with dedicated software &#40;Siemens Syngo Viewer<span class="elsevierStyleSup">&#174;</span>&#41;&#46; Parameters used by protocol were&#58; tube voltage 100 kV&#44; tube current 110 mAs&#44; reconstruction with 0&#46;75 mm sections&#44; overlap 0&#46;5 mm&#46; Typical window width&#47;level used during the procedure was 700&#47;80&#46; The best entry point and needle orientation were determined &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; We used an 18 gauge needle from the PeriVac&#8482; kit &#40;Boston Scientific<span class="elsevierStyleSup">&#174;</span>&#41;&#46; After superficial needle insertion&#44; new images of the area of interest were acquired&#46; Needle orientation was corrected as needed and the needle was advanced under aspiration&#46; New images were acquired as needed&#46; When the pericardial space was reached&#44; a drain &#40;8&#46;3F pigtail catheter from the kit&#41; was inserted through a guidewire &#40;J-tipped 0&#46;035&#8243;&#215;80 cm&#41; and final images were acquired&#46; When in doubt &#40;due to limited pericardial width at the puncture site&#41; a small amount of contrast &#40;by protocol 5 ml diluted in 10 ml of saline&#41; was injected to confirm an intra-pericardial needle position before dilation and drain insertion &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Data were stored in a dedicated computer database&#46; Statistical analysis was performed using IBM SPSS Statistics 21 &#40;2012&#41;&#46; Values are presented as mean &#177; standard deviation or median &#40;interquartile range&#41; as appropriate&#46; Normality of the sample distribution was tested using the Shapiro-Wilk test&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">Between August 2008 and February 2014&#44; 49 patients were referred for CTP&#44; which was performed in 46 patients&#46; In three patients the effusion was considered unsuitable for pericardiocentesis &#40;shallow or posterior location&#41;&#46; Patient characteristics are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">A total of 51 procedures were reported&#46; Five patients underwent repeat procedures due to recurrence of significant effusion &#40;three post-surgical&#44; two of unknown etiology&#41;&#46; The purpose of the procedure was mainly diagnostic in only two cases&#46; The most common etiologies of pericardial effusion were post-surgical &#40;48&#37;&#44; 22 cases&#41; and neoplasm-related &#40;17&#37;&#44; eight cases&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">International normalized ratio &#40;INR&#41; was measured in 33 procedures&#44; including in all patients under oral anticoagulation&#59; there were five patients with INR &#62;2&#44; with a maximum of 6&#46;88&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Procedural data are summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The procedure had a median duration of 65 &#40;50-80&#41; min and median total effective radiation exposure was 3&#46;3 &#40;2&#46;38&#8211;5&#46;17&#41; mSv&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The volume of drained fluid was variable&#44; with a mean of 781&#177;452&#46;4 ml&#46; Drainage was considered completely successful in 46 &#40;90&#37;&#41; of cases&#46; It was considered only partially successful in two cases &#40;4&#37;&#41;&#44; both due to persistent fluid accumulation in a posterior location&#59; one of them underwent successful surgical drainage&#44; the other needed no further intervention&#46; CTP was considered unsuccessful in three cases &#40;6&#37;&#41;&#44; probably due to highly septated&#47;organized effusions&#59; one had been attempted for diagnostic purposes&#44; the other two underwent successful surgical drainage&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">There were no significant immediate adverse events related to the procedure&#44; even in patients with INR &#62;2&#46; There was&#44; however&#44; one late complication&#44; with development of pyopericardium&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The results are integrated with previously published data in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">The main finding of our study is that CT is an effective and safe technique to guide pericardiocentesis&#44; which is an invasive and potentially dangerous procedure reserved for specific clinical scenarios&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In an era of multimodality imaging in cardiology&#44; blind &#40;or even ECG-guided or fluoroscopy-guided&#41; pericardiocentesis is becoming obsolete&#44; and is not recommendable&#44; except in life-saving situations&#46; Other imaging techniques may have some advantages for needle guidance&#46; Echocardiography&#44; above all&#44; is a valuable and practical option&#44; and is probably best when using a probe-mounted needle&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">19</span></a> It provides continuous real-time imaging&#44; and is widely available and probably logistically simpler and less time-consuming than CT&#46; It has&#44; however&#44; the disadvantage of not infrequent poor acoustic windows and less reliable needle tip visualization and orientation&#46; CT allows the physician to better evaluate needle direction&#44; tip positioning and relation with surrounding structures&#46; The main limitation of CT is probably its availability&#44; which is not as ubiquitous as echocardiography but is increasing&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">CTP has previously been described as safe and effective&#46; This series illustrates our good experience with this technique&#46; It encompasses a reasonable-sized sample of 46 patients&#44; almost half of them post-surgical&#44; with a high procedural success rate &#40;90&#37; complete drainage&#44; 4&#37; incomplete and 6&#37; unsuccessful&#41;&#44; and no major immediate complications recorded&#46; There was one case of pyopericardium&#44; which developed several days after the procedure&#44; performed for a significant effusion in the likely context of Dressler syndrome&#46; No immediate complications were observed and the patient was transferred back to the referring hospital&#46; He was readmitted seven days after the procedure due to recurrence of the effusion and pyopericardium was confirmed after surgical drainage&#46; The patient eventually died 52 days after the index procedure&#46; This was assumed to be a late complication of pericardiocentesis&#46; Infectious complications secondary to pericardiocentesis appear to be rare but have been described before with other imaging techniques<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">14&#44;20</span></a> and are probably related to the drainage technique&#44; rather than the imaging modality&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">These findings of high success and low complication rates are in line with the literature&#46; Duvernoy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a> reported the first series of 10 patients in 1996&#44; all with successful drainage and no major complications&#46; Bruning et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">22</span></a> described a series of 11 patients with effusions not drainable under sonographic surveillance&#44; all successful&#44; and one complication &#40;an epicardial laceration requiring surgery&#41;&#46; Klein et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a> published a single-center experience of 319 procedures with a success rate of 98&#46;4&#37; and a major complication rate of 0&#46;3&#37;&#46; In 2008 Palmer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">23</span></a> presented a series of 39 procedures in post-surgical patients&#44; all of them successful&#44; without significant complications&#44; and CTP was shown to have the additional benefit of reducing costs compared to surgical drainage&#46; Eichler et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">17</span></a> published a series of 20 patients &#40;85&#37; post-surgical&#41;&#59; all of them were successful and no major complications were reported&#46; Ceviz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">24</span></a> recently published a series of 30 patients&#44; successful in 29&#44; with one major complication &#40;hemopericardium due to epicardial injury&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Complications are more likely to occur with increasing numbers of procedures&#44; and are never completely avoidable in invasive procedures&#46; Pericardiocentesis is an invasive procedure frequently performed in frail patients&#44; and is thus associated with a non-negligible risk of complications&#46; The decision to perform it is therefore classically conservative&#44; given the potential benefit&#47;risk ratio&#46; CT guidance is proving to be an important tool in improving that ratio due to its ability to guide the procedure and increase safety&#46; Holistic&#44; informed&#44; and whenever possible evidence-based clinical judgment is essential for every decision in medicine&#46; Increasing the safety of an invasive procedure does not mean it should be performed in more patients who have smaller effusions&#46; But it certainly means it can be performed in an urgent setting&#44; before there is frank hemodynamic instability&#44; which is preferable to an emergent setting&#44; with the patient in cardiac tamponade&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In line with the published literature&#44; this work provides evidence for the feasibility&#44; advantages and disadvantages of CTP&#44; when using a standardized protocol&#44; performed by experienced physicians and in specific clinical settings&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Limitations</span><p id="par0105" class="elsevierStylePara elsevierViewall">This is a retrospective descriptive analysis of the experience of a single center with clinical expertise in cardiac MDCT&#46; Additionally&#44; this is a tertiary center with a locally available catheterization laboratory and cardiac surgery facilities&#46; Therefore&#44; our data reflect a specific hospital population that may preclude generalization of the findings&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0110" class="elsevierStylePara elsevierViewall">In our experience CTP is an effective and safe option in patients with clinical indications for pericardial fluid drainage&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical disclosures</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Protection of human and animal subjects</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Confidentiality of data</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Right to privacy and informed consent</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pericardial effusion is a common complication in clinical situations such as cardiothoracic surgery and cancer&#44; in which pericardiocentesis may be essential&#46; Pericardiocentesis can be guided by different imaging techniques&#44; most commonly echocardiography&#46; Computed tomography &#40;CT&#41; has significant advantages but there is still little evidence supporting its use in this context&#46; In this work we describe our experience with CT-guided pericardiocentesis &#40;CTP&#41; in a single center&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patients referred for CTP between August 2008 and February 2014 were retrospectively analyzed&#46; We assessed demographics&#44; etiology of the effusion&#44; international normalized ratio during the procedure&#44; radiation doses&#44; success rate and complications&#46; Results were compared with those in the literature&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">During this period&#44; 51 procedures were performed&#44; in 46 patients&#46; Five patients underwent a repeat procedure due to recurrence of effusion&#46; The most common etiologies were post-surgical &#40;48&#37;&#44; 22 patients&#41; and neoplasm-related &#40;17&#37;&#44; eight patients&#41;&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Drainage was considered completely successful in 46 cases &#40;90&#37;&#41;&#44; partially successful in two &#40;4&#37;&#41; and unsuccessful in three &#40;6&#37;&#41;&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The median duration of the procedure was 65 min &#40;interquartile range 50&#8211;80&#41; and median effective radiation exposure was 3&#46;3 mSv &#40;interquartile range 2&#46;4&#8211;5&#46;2 mSv&#41;&#46; There were no significant adverse events related to the procedure&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">By providing high-definition three-dimensional images&#44; CTP enables accurate positioning of pericardiocentesis material&#46; It was shown to be an accurate&#44; effective and safe method&#44; in agreement with previous findings&#46; CTP should be considered a good option in centers with CT facilities&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">O derrame peric&#225;rdico &#233; uma complica&#231;&#227;o tem&#237;vel em v&#225;rias situa&#231;&#245;es cl&#237;nicas&#44; em que a pericardiocentese pode ter um papel fundamental&#46; Esta pode ser guiada por v&#225;rios m&#233;todos de imagem&#44; sobretudo ecocardiografia&#46; A tomografia computorizada &#40;TC&#41; tem v&#225;rias vantagens&#44; mas o seu uso tem ainda fraca evid&#234;ncia cl&#237;nica&#46; Neste trabalho &#233; reportada a experi&#234;ncia de um centro em pericardiocentese guiada por TC &#40;P-TC&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Foram analisados retrospetivamente pacientes &#40;pts&#41; referenciados para P-TC durante o per&#237;odo de agosto de 2008 a fevereiro de 2014&#46; Foi avaliada a demografia&#44; etiologia do derrame&#44; INR&#44; radia&#231;&#227;o&#44; sucesso e complica&#231;&#245;es&#44; sendo os resultados comparados aos publicados na literatura&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Durante este per&#237;odo&#44; foram realizados 51 procedimentos em 46 doentes&#46; Cinco doentes repetiram o procedimento devido a recorr&#234;ncia do derrame&#46; A idade m&#233;dia foi de 63&#177;13&#44;8 anos&#46; As etiologias mais frequentes foram p&#243;s-cir&#250;rgica &#40;48&#37;&#44; 22 pts&#41; e neoplasia &#40;17&#37;&#44; oito pts&#41;&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">A drenagem foi considerada completa em 90&#37; &#40;46&#41; dos casos&#44; parcial em 4&#37; &#40;dois&#41; e ineficaz em 6&#37; &#40;tr&#234;s&#41;&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">O procedimento teve uma dura&#231;&#227;o mediana de 65 minutos &#40;Q1-Q3 50-80 minutos&#41; e a exposi&#231;&#227;o de radia&#231;&#227;o foi de 3&#44;3 mSv &#40;Q1-Q3 2&#44;4-5&#44;2 mSv&#41;&#46; N&#227;o foram detetadas complica&#231;&#245;es imediatas relevantes&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Ao providenciar imagens de alta defini&#231;&#227;o em tr&#234;s dimens&#245;es&#44; a P-TC permite o posicionamento preciso do material de pericardiocentese&#44; tendo demonstrado nesta s&#233;rie ser um m&#233;todo eficaz e seguro&#44; indo ao encontro da informa&#231;&#227;o previamente publicada&#46; A P-TC deve&#44; por isso&#44; ser considerada uma boa op&#231;&#227;o em centros com disponibilidade de TC&#46;</p></span>"
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            "titulo" => "M&#233;todos"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Use of computed tomography in pericardiocentesis&#46; &#40;a&#41; Characterization and assessment of effusion&#59; &#40;b&#41; determination of best entry point and needle orientation&#59; &#40;c&#41; control of needle progression and relation with surrounding structures&#59; &#40;d&#41; pigtail positioning&#59; &#40;e&#41; final result and control of evolution&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Example of a case in which intrapericardial contrast was used&#46; &#40;a&#41; Coronal view&#59; &#40;b&#41; sagittal view&#59; &#40;c&#41; axial view&#46;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">ASD&#58; atrial septal defect&#59; BMI&#58; body mass index&#59; CABG&#58; coronary artery bypass grafting&#59; EPS&#58; electrophysiological study&#59; INR&#58; international normalized ratio&#59; MI&#58; myocardial infarction&#59; VSD&#58; ventricular septal defect&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#177;13&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Gender</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Male</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;54&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;45&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">BMI &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleBold">2</span></span><span class="elsevierStyleBold">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#177;4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Etiology of effusion</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Post-surgical</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;48&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Valvular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>CABG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Valvular &#43; CABG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>ASD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>VSD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Other surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Neoplasm</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Lung&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Ovary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Neuroendocrine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Breast&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Stomach&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Heart failure</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Autoimmune</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Other</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Free wall rupture after MI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Acute pericarditis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Hyperuricemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Complication of EPS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Unknown</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Referring service</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cardiology</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cardiothoracic surgery</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Purpose of procedure</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diagnostic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Therapeutic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49 &#40;96&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Success</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;94&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Complete&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46 &#40;90&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Incomplete&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Insuccess</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Effective radiation &#40;mSv&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;3 &#40;IQR 2&#46;4-5&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Drained volume &#40;ml&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">781&#177;452&#46;4 &#40;10&#8211;2000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Fluid type</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Clear yellow&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Serosanguineous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sanguineous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Data not available&#47;unknown&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Contrast use &#40;no&#46; of procedures&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Repeat procedures &#40;no&#46; of procedures&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Time between procedures &#40;median in days&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;7&#8211;111&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Authors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Year of publication&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">No&#46; of procedures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Success&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Complications</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Minor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Major&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duvernoy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1996&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bruning et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Klein et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">319&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">314 &#40;98&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;6&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Palmer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">23</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Eichler et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ceviz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">24</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;97&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Current study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48 &#40;94&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Total&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">480&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">471 &#40;98&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;0&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Published series&#46;</p>"
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      "titulo" => "References"
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        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:24 [
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              "identificador" => "bib0125"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Clinical clues to the causes of large pericardial effusions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Sagrist&#224;-Sauleda"
                            1 => "J&#46; Merc&#233;"
                            2 => "G&#46; Permanyer-Miralda"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "2000"
                        "volumen" => "109"
                        "paginaInicial" => "95"
                        "paginaFinal" => "101"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10967149"
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            1 => array:3 [
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Postoperative cardiac tamponade in the modern surgical era"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;T&#46; Kuvin"
                            1 => "N&#46;A&#46; Harati"
                            2 => "N&#46;G&#46; Pandian"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2002"
                        "volumen" => "74"
                        "paginaInicial" => "1148"
                        "paginaFinal" => "1153"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12400760"
                            "web" => "Medline"
                          ]
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            2 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of pericardial effusion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Imazio"
                            1 => "Y&#46; Adler"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehs372"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2013"
                        "volumen" => "34"
                        "paginaInicial" => "1186"
                        "paginaFinal" => "1197"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23125278"
                            "web" => "Medline"
                          ]
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                ]
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            3 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "4"
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                0 => array:2 [
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ISSN: 08702551
Idioma original: Inglês
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