Original article
Cardiovascular
Video-Assisted Thoracoscopic Pericardial Window for Diagnosis and Management of Pericardial Effusions

https://doi.org/10.1016/j.athoracsur.2005.02.068Get rights and content

Background

Video-assisted thoracoscopy with the creation of a pericardial window is a noninvasive method of pericardial drainage. It also allows an excellent view of both the pleural cavity and pericardium and the precise selection of biopsy sites. We review our 3-year experience with this technique.

Methods

Between January 2001 and February 2004, 18 patients (10 men, 8 women; mean age 57 years) with echocardiographically diagnosed pericardial effusion underwent video-assisted thoracoscopy at our center. Pericardial windows were created under general anesthesia and single-lung ventilation using 2 to 3 trocars. Mean operating time was 46 minutes. A right thoracic approach was used in 16 patients and a left thoracic approach in 2.

Results

Microbiology and virology cultures of the pericardial fluid were negative. Histologic findings were compatible with tuberculosis in 2 cases and granulocytic sarcoma, infiltrating breast carcinoma, and infiltrating nonsmall cell carcinoma in 1 case each. In the remaining patients, the histologic diagnosis was chronic or subacute nonspecific pericarditis. Talc pleurodesis was performed in 3 patients for concomitant malignant pleural effusion. In 4 patients, the pericardial effusion occurred secondary to cardiac surgery; 3 were receiving anticoagulants after valve replacement, and 1 had a heart transplant. There were no complications of the thoracoscopy technique.

Conclusions

Video-assisted thoracoscopic fenestration is an effective technique for pericardial drainage and biopsy. Apart from its diagnostic value, it allows the physician to fashion a pleuropericardial window for effective drainage while avoiding the complications of classic surgical procedures. Concomitant pleural and pulmonary disorders may be managed simultaneously.

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,

References (17)

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