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Pulle MV, Bansal M, Asaf BB, Puri HV, Bishnoi S, Kumar A. Safety and feasibility of thoracoscopic pericardial window in recurrent pericardial effusion - A single-centre experience. J Minim Access Surg 2024; 20:19-23. [PMID: 38240383 PMCID: PMC10898635 DOI: 10.4103/jmas.jmas_144_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/23/2022] [Accepted: 08/28/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This study aimed to report the surgical outcomes and also evaluating the safety and feasibility of thoracoscopic pericardial window (PW) for recurrent pericardial effusion. MATERIALS AND METHODS This was a retrospective analysis of eight cases of recurrent pericardial effusion, managed by thoracoscopic method in a tertiary-level thoracic surgery centre over 5 years. A detailed analysis of all perioperative variables, including complications, was carried out. RESULTS A total of eight patients underwent thoracoscopic PW during the study period. Males (87.5%) were predominant in the cohort. The median age was 54 years (range: 28-78 years). The median duration of symptoms was 2 months (range: 1-3 months). Tuberculosis (50%), malignancy (37.5%) and chronic kidney disease (12.5%) were the causes of recurrent effusion. All patients underwent thoracoscopic procedure with no conversions. The median operative time was 45 min (range: 40-70 min). The median effusion volume drained was 500 ± 100 ml. The median hospital stay was 3 days (range: 2-4 days) with no post-procedural complications. All the patients had complete resolution of symptoms. No recurrence was noted in the median follow-up period of 28 months (range: 6-60 months). CONCLUSIONS Thoracoscopic PW is a safe and feasible minimally invasive option in the management of recurrent pericardial effusion in selected patients. Surgical fitness, haemodynamic status and estimated survival (in malignant effusion) should be considered before the procedure.
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Affiliation(s)
- Mohan Venkatesh Pulle
- Department of Thoracic Surgery, Institute of Chest Surgery, Medanta – The Medicity, Gurugram, Haryana, India
| | - Manish Bansal
- Department of Cardiology, Institute of Heart Sciences, Medanta – The Medicity, Gurugram, Haryana, India
| | - Belal Bin Asaf
- Department of Thoracic Surgery, Institute of Chest Surgery, Medanta – The Medicity, Gurugram, Haryana, India
| | - Harsh Vardhan Puri
- Department of Thoracic Surgery, Institute of Chest Surgery, Medanta – The Medicity, Gurugram, Haryana, India
| | - Sukhram Bishnoi
- Department of Thoracic Surgery, Institute of Chest Surgery, Medanta – The Medicity, Gurugram, Haryana, India
| | - Arvind Kumar
- Department of Thoracic Surgery, Institute of Chest Surgery, Medanta – The Medicity, Gurugram, Haryana, India
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Çardak ME, Külahçioglu S, Erdem E. Awake uniportal video-assisted thoracoscopic surgery for the management of pericardial effusion. J Minim Access Surg 2023; 19:482-488. [PMID: 37148107 PMCID: PMC10695308 DOI: 10.4103/jmas.jmas_337_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/12/2023] [Indexed: 05/07/2023] Open
Abstract
Introduction Pericardial drainage can be performed either with pericardiocentesis or pericardial "window" in cases with hemodynamic compromise for therapeutic and diagnostic purposes. Awake single-port video-assisted thoracoscopic surgery (VATS) is an alternative to pericardial window (PW) that has been described only in case reports in the literature. We aimed to analyse a series of patients with chronic, recurrent and/or large pericardial effusions who underwent single-port VATS-PW opening without intubation. Patients and Methods The PW was opened using awake single-port VATS in 20 of 23 patients referred to our clinic with recurrent, chronic and/or large pericardial effusion between December 2021 and July 2022. Demographic data, imaging modalities, treatment processes and pathological samples were analysed retrospectively. Results The median age of 20 patients was 68 years (52-81). The mean body mass index was 29.1 ± 6.0 kg/m2 and mean pericardial fluid measurements with pre-operative transthoracic echocardiography (TTE) was 2,8 ± 0,9 cm. The mean operation time was 44 ± 13.0 min and mean peri-operative drainage was 700 ± 307 cc. On the 1st post-operative day, control TTE revealed ≤0.5 cm effusion in 18 (90%) patients and ≥0.5 cm in 2 (10%) patients. The median day of discharge or referral to the clinic where they are followed up was 1 (1-2). Conclusions Awake single-port VATS could be used safely in all patient groups with pericardial effusion or tamponade as a diagnostic and therapeutic option. This technique has advantages, especially in patients with high surgical risk.
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Affiliation(s)
- Murat Ersin Çardak
- Department of Thoracic Surgery, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Seyhmus Külahçioglu
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Esin Erdem
- Department of Anesthesiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
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Adler Y, Ristić AD, Imazio M, Brucato A, Pankuweit S, Burazor I, Seferović PM, Oh JK. Cardiac tamponade. Nat Rev Dis Primers 2023; 9:36. [PMID: 37474539 DOI: 10.1038/s41572-023-00446-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/22/2023]
Abstract
Cardiac tamponade is a medical emergency caused by the progressive accumulation of pericardial fluid (effusion), blood, pus or air in the pericardium, compressing the heart chambers and leading to haemodynamic compromise, circulatory shock, cardiac arrest and death. Pericardial diseases of any aetiology as well as complications of interventional and surgical procedures or chest trauma can cause cardiac tamponade. Tamponade can be precipitated in patients with pericardial effusion by dehydration or exposure to certain medications, particularly vasodilators or intravenous diuretics. Key clinical findings in patients with cardiac tamponade are hypotension, increased jugular venous pressure and distant heart sounds (Beck triad). Dyspnoea can progress to orthopnoea (with no rales on lung auscultation) accompanied by weakness, fatigue, tachycardia and oliguria. In tamponade caused by acute pericarditis, the patient can experience fever and typical chest pain increasing on inspiration and radiating to the trapezius ridge. Generally, cardiac tamponade is a clinical diagnosis that can be confirmed using various imaging modalities, principally echocardiography. Cardiac tamponade is preferably resolved by echocardiography-guided pericardiocentesis. In patients who have recently undergone cardiac surgery and in those with neoplastic infiltration, effusive-constrictive pericarditis, or loculated effusions, fluoroscopic guidance can increase the feasibility and safety of the procedure. Surgical management is indicated in patients with aortic dissection, chest trauma, bleeding or purulent infection that cannot be controlled percutaneously. After pericardiocentesis or pericardiotomy, NSAIDs and colchicine can be considered to prevent recurrence and effusive-constrictive pericarditis.
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Affiliation(s)
- Yehuda Adler
- Sackler Faculty of Medicine, Tel Aviv University, Bnei Brak, Israel.
- College of Law and Business, Ramat Gan, Israel.
| | - Arsen D Ristić
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
| | - Massimo Imazio
- Cardiothoracic Department, Cardiology, University Hospital Santa Maria della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Antonio Brucato
- Department of Biomedical and Clinical Sciences, Fatebenefratelli Hospital, The University of Milan, Milan, Italy
| | - Sabine Pankuweit
- Department of Internal Medicine-Cardiology, Philipps University Marburg, Marburg, Germany
| | - Ivana Burazor
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Institute for Cardiovascular Diseases "Dedinje" and Belgrade University, Faculty of Medicine, Belgrade, Serbia
| | - Petar M Seferović
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Sigusch HH, Geisler W, Surber R, Schönweiß M, Gerth J. Percutaneous balloon pericardiotomy: efficacy in a series of malignant and nonmalignant cases. SCAND CARDIOVASC J 2022; 56:331-336. [PMID: 35982636 DOI: 10.1080/14017431.2022.2111463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVE In the case of malignant pericardial effusion and cardiac tamponade, balloon pericardiotomy is an established minimally invasive option to the surgical creation of a subxiphoid pericardial window. Percutaneous balloon pericardiotomy effectively drains recurrent pericardial fluid by creating a pleuro (-abdominal-) pericardial communication. Design. A series of 26 patients with underlying malignant (n = 12) and nonmalignant (n = 14) diseases underwent percutaneous balloon pericardiotomy between 2008 and 2021. All interventions were done through a subxiphoid access under local anesthesia. Results. The mean survival in the malignant and nonmalignant groups was 1.2 versus 48.0 months, respectively (p < .001). There were neither severe periinterventional complications nor in-hospital deaths. In two patients with nonmalignant disease the surgical creation of a pericardial window was necessary during follow-up. The originally described procedure was modified by the removal of all catheters at the end of the intervention. The procedure was safe. It prevented immobility and facilitated an early discharge from the hospital. Conclusion. Our experiences show that percutaneous balloon pericardiotomy is a minimally invasive approach to successfully provide palliation in the group of patients with underlying malignant disease. On the other hand, we have shown that this technique is safe and feasible in the treatment of pericardial effusion based on nonmalignant disease. We think thereby that pericardial balloon pericardiotomy can be considered as a less invasive alternative to surgery in both groups of patients.
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Affiliation(s)
- Holger H Sigusch
- Department of Internal Medicine, Division of Cardiology, Heinrich-Braun-Klinikum, Zwickau, Germany
| | - Wolff Geisler
- Department of Internal Medicine, Division of Cardiology, Heinrich-Braun-Klinikum, Zwickau, Germany
| | - Ralf Surber
- Department of Internal Medicine, Division of Cardiology, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Marc Schönweiß
- Department of Internal Medicine, Division of Cardiology, Heinrich-Braun-Klinikum, Zwickau, Germany
| | - Jens Gerth
- Department of Internal Medicine, Division of Nephrology, Heinrich-Braun-Klinikum, Zwickau, Germany
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The Association of Minimally Invasive Surgical Approaches and Mortality in Patients with Malignant Pleuropericarditis—A 10 Year Retrospective Observational Study. Medicina (B Aires) 2022; 58:medicina58060718. [PMID: 35743981 PMCID: PMC9229806 DOI: 10.3390/medicina58060718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/18/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Malignant neoplasms are common causes of acute pleuropericardial effusion. Pleuropericarditis denotes poor patient prognosis, is associated with shortened average survival time, and represents a surgical emergency. Materials and Methods: We analyzed the impact of two minimally invasive surgical approaches, the type of cancer, and other clinical variables on the mortality of 338 patients with pleuropericarditis admitted to an emergency hospital in Romania between 2009 and 2020. All patients underwent minimally invasive surgeries to prevent the recurrence of the disease and to increase their life expectancy. Log-rank tests were used to check for survival probability differences by surgical approach. We also applied univariate and multivariate Cox proportional hazard models to assess the effect of each covariate. Results: No significant differences were found in the 2-year overall survival rate between patients who underwent the two types of surgery. The multivariate Cox proportional regression model adjusted for relevant covariates showed that age, having lung cancer, and a diagnosis of pericarditis and right pleural effusion increased the mortality risk. The surgical approach was not associated with mortality in these patients. Conclusion: These findings open up avenues for future research to advance the understanding of survival among patients with pleuropericarditis.
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Amamoto S, Sato M, Kawasaki H, Naito K. A case of surgery applying a Denver shunt for intractable pericardial effusion. Asian Cardiovasc Thorac Ann 2019; 28:126-128. [PMID: 31830421 DOI: 10.1177/0218492319896507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report our experience in the application of a Denver shunt as surgical treatment for intractable pericardial effusion. The patient was a 60-year-old woman who suffered from pericarditis accompanied by intractable pericardial effusion as complications of systemic lupus erythematosus. Pericardial fenestration with thoracoscopic assistance and a right pleuroperitoneal shunt using a Denver shunt were performed as surgical treatment. Postoperatively, the patient’s heart failure symptoms disappeared and her pericardial effusion was considerably reduced. The postoperative course was uneventful without recurrence after a 2-year follow-up period.
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Affiliation(s)
- Sojiro Amamoto
- Department of Cardiovascular Surgery, Saga-ken Medical Centre Koseikan, Saga, Japan *This is a secondary publication of the paper published in Japanese Journal of Cardiovascular Surgery 2019; 48(2): 125-127
| | - Manabu Sato
- Department of Cardiovascular Surgery, Saga-ken Medical Centre Koseikan, Saga, Japan *This is a secondary publication of the paper published in Japanese Journal of Cardiovascular Surgery 2019; 48(2): 125-127
| | - Hiromitsu Kawasaki
- Department of Cardiovascular Surgery, Saga-ken Medical Centre Koseikan, Saga, Japan *This is a secondary publication of the paper published in Japanese Journal of Cardiovascular Surgery 2019; 48(2): 125-127
| | - Kozo Naito
- Department of Cardiovascular Surgery, Saga-ken Medical Centre Koseikan, Saga, Japan *This is a secondary publication of the paper published in Japanese Journal of Cardiovascular Surgery 2019; 48(2): 125-127
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Zhang J, Zhang Q, Chen X, Zhang N. Management of neoplastic pericardial disease. Herz 2019; 45:46-51. [PMID: 31297544 DOI: 10.1007/s00059-019-4833-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/07/2019] [Accepted: 06/14/2019] [Indexed: 12/14/2022]
Abstract
At present, there is no accurate and effective method for treating neoplastic pericardial effusion. This study analyzed the current literature on the treatment of neoplastic pericardial effusion to provide advice and guidance for clinical treatment. Surgical treatments include pericardial puncture, extension of catheter drainage, pericardial window, and surgical pericardiotomy. Each surgical procedure has a corresponding indication, and the best treatment is selected according to the patient's specific conditions. Systemic chemotherapy is effective in lymphoma and small cell lung cancer that are sensitive to chemotherapeutic drugs. Although pericardial injection of drugs is effective for pericardial tamponade and recurrent pericardial effusion, these methods can only temporarily relieve symptoms and cannot prolong the life of patients. In recent years, immunotherapy, especially adoptive immunotherapy, has achieved good results in the treatment of neoplastic pericardial effusion, thus providing a novel treatment option for neoplastic pericardial effusion.
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Affiliation(s)
- J Zhang
- Department of Cardiology, the Fourth Affiliated Hospital of Hebei Medical University, 050011, Shijiazhuang, Hebei Province, China
| | - Q Zhang
- Department of Clinical Medicine, Basic Medical College of Seven Years (2014), Hebei Medical University, 050017, Shijiazhuang, Hebei Province, China
| | - X Chen
- Department of Clinical Medicine, Basic Medical College of Seven Years (2014), Hebei Medical University, 050017, Shijiazhuang, Hebei Province, China
| | - N Zhang
- Department of Cardiology, the Fourth Affiliated Hospital of Hebei Medical University, 050011, Shijiazhuang, Hebei Province, China.
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8
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A Rare Case of Pericardial Effusion in a Patient with Silicosis. Case Rep Cardiol 2019; 2019:5068580. [PMID: 31281677 PMCID: PMC6590561 DOI: 10.1155/2019/5068580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/15/2019] [Indexed: 11/17/2022] Open
Abstract
Silicosis is an occupational lung disorder caused by inhalation of silica dust. It not only causes respiratory disorders but also affects other organs. We report an extremely rare case of silicosis complicated by pericarditis in an 83-year-old male. He had been working as a coal miner and was diagnosed with silicosis at the age of 63. Because he had experienced repeated pericardial effusions, he was referred for a surgical pericardial biopsy to elucidate the cause of his repeated pericardial effusion and to perform pericardial fenestration. Thoracoscopic surgery was performed. The pericardium was resected, and a drain was placed in the left thoracic cavity. Histopathological examination revealed the pericardial degeneration due to silicosis, suggesting that pericarditis and pericardial effusion are related to silicosis. The operation was successful, and he experienced no recurrence of pericardial effusion at the 7-month follow-up.
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9
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Salim EF, Rezk ME. Thoracoscopic versus subxiphoid pericardial window in patients with end-stage renal disease. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.jescts.2018.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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10
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Single-Port Thoracoscopic Pericardial Window Under Local Anesthesia. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:62-64. [PMID: 29432361 DOI: 10.1097/imi.0000000000000456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There are numerous surgical approaches for the treatment of pericardial effusions but no clear consensus of best management. We present a 44-year-old woman with metastatic breast cancer presenting with a new 2-cm pericardial effusion on ultrasound. In light of the patient's palliative condition and the urgent need for chemotherapy, careful consideration was made for her surgical drainage of the pericardial effusion. Because of the patient's medical comorbidities, a general anesthetic was deemed not to be in the patient's best interest. Furthermore, the invasive subxiphoid or thoracotomy approach for a pericardial window would have risked delaying her much needed chemotherapy. A single-port thoracoscopic pericardial window was performed under light sedation, ventilating spontaneously on supplementary oxygen through nasal cannula only. The patient was positioned in a supine position, and a single 8-mm port was inserted into the left hemithorax at the 5th intercostal space, midaxillary line under local anesthetic, and a pericardial window made. This minimally invasive approach, without the need for intubation or ventilation, allowed for rapid relief of symptoms and discharge for the patient to begin her chemotherapy in a timely manner. By undergoing the procedure awake and through a single port, the patient was discharged after a short inpatient stay. This novel approach can be advocated for patients where a general anesthetic or invasive surgical procedure is not suitable in the treatment of their pericardial effusion.
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11
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Park CY, McGonigle NC. Single-Port Thoracoscopic Pericardial Window under Local Anesthesia. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698451801300113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Chang Y. Park
- Department of Thoracic Surgery, Harefield Hospital, London, UK
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12
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Affiliation(s)
| | | | | | - Mike Faurie
- Edendale Hospital, Pietermaritzburg, South Africa
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13
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Surgical pericardial drainage in a series of 235 consecutive patients: an 8-year experience. Indian J Thorac Cardiovasc Surg 2016. [DOI: 10.1007/s12055-016-0461-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Sakanoue I, Hamakawa H, Okubo Y, Minami K, Miyamoto E, Shomura Y, Takahashi Y. Efficacy and safety of thoracoscopic pericardial window in patients with pericardial effusions: a single-center case series. J Cardiothorac Surg 2016; 11:92. [PMID: 27297223 PMCID: PMC4906769 DOI: 10.1186/s13019-016-0488-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 06/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background Pericardial effusion (PE) is a common finding in patients who had chronic cardiac failure, who had undergone cardiac surgery, or who had certain other benign and malignant diseases. PE ranges in severity from mild, asymptomatic effusions to cardiac tamponade. Although a thoracoscopic pericardial window (TPW) is a minimally invasive surgical option for patients with PE, there are few published data regarding the outcomes of TPW for PE. We investigated the contribution of the TPW to the treatment of PEs that are recurrent or difficult to drain percutaneously. Methods We conducted a retrospective chart review of the indications for TPW that included data on preoperative, intraoperative, and postoperative variables; morbidity; recurrence; and survival. Fourteen consecutive patients with PE that was recurrent or difficult to drain percutaneously and who underwent treatment with a TPW were enrolled in this study. Trocars for passage of the thoracoscope and surgical instruments were introduced through two or three incisions. Mini-thoracotomy was also performed in patients with hemopericardium and loculated fibrinous effusions. All patients were evaluated by face-to-face interviews, transthoracic echocardiography (TTE), and chest radiography 3–6 months after the TPW was obtained. Results The mean age of the patients was 70 years (range 28–83 years). The operative time was 72.1 ± 29.5 min. Six patients had undergone open heart surgery during the month prior to their presentation with PE. No intraoperative or postoperative complications occurred, although PE had recurred in one patient. Two patients died of malignant disease several months after the TPW. The cardiothoracic ratio (determined on chest radiographs) and the ejection fraction ratio (determined using TTE) had improved at the 3- and 6-month follow-up evaluations (p < 0.0001 and p = 0.012, respectively). Some patients could discontinue diuretics after the procedure, as assessed by the cardiologist based on symptom alleviation, chest radiography, and TTE findings. Conclusions For patients with PEs that are recurrent or difficult to drain percutaneously, TPW is an effective, safe surgical approach in terms of cardiac function and radiological findings.
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Affiliation(s)
- Ichiro Sakanoue
- Thoracic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-machi, Chuo-ku, Kobe, 650-0047, Japan.
| | - Hiroshi Hamakawa
- Thoracic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-machi, Chuo-ku, Kobe, 650-0047, Japan
| | - Yu Okubo
- Thoracic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-machi, Chuo-ku, Kobe, 650-0047, Japan
| | - Kazuhiro Minami
- Thoracic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-machi, Chuo-ku, Kobe, 650-0047, Japan
| | - Ei Miyamoto
- Thoracic Surgery, Graduate School of Medicine, Kyoto University Hospital, 54 Kawaracho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yu Shomura
- Cardiovascular and Thoracic Surgery, Shingu Municipal Medical Center, 18-7 Hachibuse, Shingu, Wakayama, 647-0072, Japan
| | - Yutaka Takahashi
- Thoracic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-machi, Chuo-ku, Kobe, 650-0047, Japan
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15
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Altman E, Rutsky O, Shturman A, Yampolsky Y, Atar S. Anterior parasternal approach for creation of a pericardial window. Ann R Coll Surg Engl 2015; 97:375-8. [PMID: 26264090 PMCID: PMC5096577 DOI: 10.1308/003588415x14181254789925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The optimal method for creation of a pericardial window (PW) is still controversial and it remains a surgical challenge, mainly in obese patients. The aim of this study was to evaluate the efficacy and safety of a novel approach that has not been described previously, for creation of a PW in patients with symptomatic, chronic, large pericardial effusion. METHODS We retrospectively analysed the records of 30 patients (14 men, 16 women) who underwent a PW procedure between 2001 and 2011. The mean age was 63 years (standard deviation [SD]: 17 years, median: 60 years, range: 27-90 years) and the mean body mass index was 34 kg/m(2) (SD: 2 kg/m(2)). The operation was performed through a curvilinear parasternal approach, 6-8 cm in length, followed by a mini-thoracotomy between ribs 4 and 5. Discharged patients were followed up clinically. RESULTS The mean operative time was 73 minutes (SD: 21 minutes) and a median of 658 ml (range: 300-1,500 ml) of fluid was evacuated. The main aetiologies were idiopathic in 17 patients (57%) and malignant in 9 (30%). Seven patients (23%) died in hospital owing to underlying malignancy. Postoperative complications included mild renal failure (20%), respiratory failure (20%), pneumonia (13%), atrial fibrillation (10%) and atelectasis (6%). There were no wound infections. The median length of stay following the procedure was 8 days. In a median follow-up period of 3.8 years, 16 patients with non-malignant effusion were free of recurrence of pericardial effusion. CONCLUSIONS The anterior parasternal approach for creation of a PW is simple, safe and efficacious, and results in long-term symptomatic improvement, specifically in patients with non-malignant effusions. This approach may be more appealing in obese patients.
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Affiliation(s)
- E Altman
- Galilee Medical Centre, Nahariya, Israel
| | - O Rutsky
- Galilee Medical Centre, Nahariya, Israel
| | - A Shturman
- Galilee Medical Centre, Nahariya, Israel
| | | | - S Atar
- Galilee Medical Centre, Nahariya, Israel
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Agrawal V, Saxena A, Sethi A, Acharya H, Sharma D. Thoracoscopic pericardiotomy for management of purulent pneumococcal pericarditis in a child. Asian J Endosc Surg 2012; 5:145-8. [PMID: 22823173 DOI: 10.1111/j.1758-5910.2011.00129.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Purulent pericarditis is an extremely rare complication of pneumococcal pneumonia in children that may result in to cardiac tamponade. While image-guided pericardiocentesis is the treatment of choice for such a condition, it may fail in the presence of thick pus; loculations and thoracoscopic pericardiotomy are useful procedures for such situations. Herein, we report such a case involving a 6-year-old boy who presented with purulent pneumococcal pericarditis that was managed with thoracoscopic pericardiotomy and who recovered well. Thoracoscopic pericardiotomy is a safe procedure that allows effective drainage under vision, pericardial biopsy for diagnosis, and a simultaneous opportunity to perform thoracoscopic pleural drainage.
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Affiliation(s)
- V Agrawal
- Department of Pediatric Surgery, NSCB Government Medical College, Jabalpur, India.
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Celik S, Celik M, Aydemir B, Tanrıkulu H, Okay T, Tanrikulu N. Surgical properties and survival of a pericardial window via left minithoracotomy for benign and malignant pericardial tamponade in cancer patients. World J Surg Oncol 2012; 10:123. [PMID: 22742716 PMCID: PMC3499191 DOI: 10.1186/1477-7819-10-123] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 06/02/2012] [Indexed: 01/31/2023] Open
Abstract
Background Surgical drainage is a rapid and effective treatment for pericardial tamponade in cancer patients. We aimed to investigate the effectiveness of pericardial window formation via mini-thoracotomy for treating pericardial tamponade in cancer patients, and to evaluate clinical factors affecting long-term survival. Methods Records of 53 cancer patients with pericardial tamponade treated by pericardial window formation between 2002 and 2008 were examined. Five patients were excluded due to insufficient data. Kaplan-Meier and Cox regression analysis were used for analysis. Results Forty-eight patients (64.7% male), with a mean age of 55.20 ± 12.97 years were included. Patients were followed up until the last control visit or death. There was no surgery-related mortality and the 30-day mortality rate was 8.33%; all died during postoperative hospitalization. Morbidity rate was 18.75%. Symptomatic recurrence rate was 2.08%. Cancer type and nature of the pericardial effusion were the major factors determining long-term survival (P <0.001 and P <0.004, respectively). Overall median survival was 10.41 ± 1.79 months. One- and 2-year survival rates were 45 ± 7% and 18 ± 5%, respectively. Conclusion Pericardial window creation via minithoracotomy was proven to be a safe and effective approach in surgical treatment of pericardial tamponade in cancer patients. Cancer type and nature of pericardial effusion were the main factors affecting long-term survival.
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Affiliation(s)
- Sezai Celik
- Department of Thoracic Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
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Ng CSH, Wong RHL, Yeung ECL, Kwok MWT, Lau RWH, Ho AMH, Yim APC, Underwood MJ. Needlescopic video-assisted thoracoscopic pericardial window. SURGICAL PRACTICE 2012. [DOI: 10.1111/j.1744-1633.2012.00595.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gilbert S, Kilic A, Yaeger K, Toyoda Y, Bermudez C, Siegenthaler MP, Kormos RL. Minimally invasive approach to thoracic effusions in patients with ventricular assist devices. Interact Cardiovasc Thorac Surg 2011; 14:44-7. [PMID: 22108930 DOI: 10.1093/icvts/ivr020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The aim of this study was to compare our experience between open and video-assisted thoracic surgery (VATS) approaches to the management of thoracic effusions in ventricular assist device (VAD) patients. This was a retrospective review of a prospectively collected database of VAD patients at a single institution. Patients who were operated on for pericardial and/or pleural effusions were included. Primary outcomes included operative mortality and morbidity as well as effusion recurrence. From 1993 to 2009, 360 adult patients underwent VAD placement. Twenty-three patients (11.9%) required operative management of pleural (n = 24), pericardial (n = 13) or both pleural and pericardial (n = 6) effusions [open = 20 (47%); VATS = 23 (53%)]. Drainage with decortication was performed in five patients, with the remaining undergoing drainage alone. Open and VATS patients were similar in age, gender and indication for VAD support. Conversion from VATS to open was necessary in four patients (17%). There was no operative mortality and no difference in perioperative complications between approaches. The open and VATS approaches had similar rates of pleural (open = 63%; VATS = 41%; P = 0.42) and pericardial (open = 31%; VATS = 17%; P = 1) effusion recurrences. In spite of apparent challenges, the VATS approach may be as safe and effective as open surgery for the management of pleural and pericardial effusions in VAD patients in centres with significant minimally invasive thoracic experience.
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Affiliation(s)
- Sebastien Gilbert
- Division of Thoracic Surgery, The Ottawa Hospital, General Campus, Ottawa, ONT, Canada.
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Triviño A, Cózar F, Congregado M, Gallardo G, Moreno-Merino S, Jiménez-Merchán R, Loscertales J. [Pericardial window by videothorascopy]. Cir Esp 2011; 89:677-80. [PMID: 21906729 DOI: 10.1016/j.ciresp.2011.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 02/06/2011] [Accepted: 05/19/2011] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Pericardial effusion is a clinical condition requiring multidisciplinary management. There are several surgical techniques for its diagnosis and treatment. In the present study we report our experience in performing a pericardial window (PW) by videothorascopy. MATERIAL AND METHODS We performed surgery on 56 patients (20 females and 36 males), with a mean age of 56±1.22 years, and diagnosed with moderate to severe chronic pericardial effusion. The side chosen for the approach depended on whether there was an associated pleural effusion or lung lesion, and if not the left side was chosen. RESULTS The mean duration of the surgery was 37.6±16 minutes. The definitive diagnoses were malignant processes in 23% of cases, including bronchogenic carcinoma and breast cancer. The intra-operative mortality was 0%. CONCLUSIONS Videothorascopic pericardial window is an effective and safe technique for the diagnosis and treatment of chronic pericardial effusion, and which enables it to be drained and perform a pleuro-pulmonary and/or mediastinal biopsy during the same surgical act.
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Affiliation(s)
- Ana Triviño
- Servicio de Cirugía General y Torácica, Hospital Universitario Virgen Macarena, Seville, Spain.
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