Although Dr. Frankel believes that PPDS is “just as effective and obviously less morbid” as well as less expensive than surgical techniques, there are only 140 patients in the three series he cites.3–5 Even in experienced hands, guided by echocardiography, there is a substantial risk of cardiac penetration during pericardiocentesis. Technical failure, pain, dysrhythmia, fever, infection, and cardiac arrest are described as complications of PPDS. Prolonged hospitalization is required for drainage of fluid and repeated sclerosant injections. Only 73% of effusions were controlled for > 30 days,3 and median survival periods were only 98 days, 97 days, and 30 days in the series cited. These articles do not provide information on the success of this treatment in preventing recurrent pericardial effusion and tamponade beyond 30 days.