Original articleCardiovascularVideo-Assisted Thoracoscopic Pericardial Window for Diagnosis and Management of Pericardial Effusions
Section snippets
Patients and Methods
Between January 2001 and February 2004, 18 patients with pericardial effusions underwent video-thoracoscopic surgery at our center. The group consisted of 10 men and 8 women of mean age 57 years (range, 46 to 77). Symptoms included thoracic pain (n = 2), isolated dyspnea (n = 12), or pyrexia (n = 2). Two patients were clinically asymptomatic. We included only patients with echocardiographically documented malignant (n = 3) or benign idiopathic (n = 11) pericardial effusions requiring further
Results
Preoperative echocardiography revealed septations and loculations in 7 patients (39%). Additional pleural pathology consisting of effusions and thickening or irregularities was identified on CT scan in 9 patients (50%).
The preoperative examinations combined with the postoperative results confirmed the presence of malignancy in 3 patients, including 1 with myelofibrosis. In 11 patients, there was no evidence of neoplasia. In the remaining 4 patients, all with septations and loculations, the
Comment
Symptomatic pericardiac effusions are common and may result from a variety of causes. When medical treatment has failed to control the effusion or a diagnosis is needed, surgical intervention is required.
Various approaches have been described for the diagnostic and therapeutic assessment of pericardial disease, including pericardiocentesis, percutaneous catheter drainage and balloon pericardiotomy, subxiphoid pericardial drainage, pericardioperitoneal shunt, subxiphoid pericardial fenestration,
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