Three-dimensional video-assisted thoracoscopic pericardiectomy

Video-assisted thoracic surgery has proven to be safe and effective for the diagnosis and management of pericardial disease. Three-dimensional (3-D) video imaging technology has been developed to allow the laparoscopic surgeon more precision and efficiency in advanced laparoscopic cases. This case report describes the marriage of 3-D video imaging and thoracoscopy that allowed performance of a technically difficult pericardiectomy without incident. Our aim is to describe the use of state-of-the-art 3-D video imaging to allow success in difficult cases.     

Total pericardiectomy for uremic pericarditis

Between 1973 and 1975, 19 patients were treated for uremic pericarditis. The clinical presentation of the condition varied, with some patients having minimal symptoms (chest pain, fever) and others sustaining circulatory collapse. Pericardial friction rub, elevated central venous pressure, and paradoxical pulse were the most common physical findings. Serial chest radiography, echocardiography, and cardiac scan were most useful in establishing the diagnosis. Three patients had cardiac catheterization and angiography. Pericardiectomy was the initial procedure performed in 13 of 19 patients, and there was no operative mortality or recurrence of pericarditis. Four patients initially had a pericardial window created rather than a pericardiectomy. Two had recurrence of symptoms and one required later total pericardiectomy. Two patients underwent initial tube pericardiostomy. Both died after recurrent tamponade. Total pericardiectomy appears to be the treatment of choice for uremic pericarditis and the only form of therapy which is definitive. The risk of circulatory collapse from tamponade warrants early operative intervention in this critically ill group of patients.

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Résumé De 1973 à 1975, 19 patients ont été traités pour péricardite urémique. Les malades présentaient un tableau clinique très variable, certains avaient peu de symptômes (douleurs thoraciques, température) et d'autres étaient en collapsus. Les signes physiques les plus fréquents furent le frottement péricardique, l'élévation de la pression veineuse centrale et le pouls paradoxal. Les examens les plus utiles pour l'établissement du diagnostic sont la radiographie de thorax, l'échographie et la scintigraphie cardiaque. Trois patients ont subi un cathétérisme cardiaque et une angiographie. Treize malades sur 19 ont subi d'emblée une péricardectomie sans mortalité opératoire ni récidive de la péricardite. Chez 4 patients, une fenêtre antérieure a été créée dans le péricarde, les symptômes sont réapparus chez 2 malades et l'un d'eux dut subir une péricardectomie. Un simple drainage a été réalisé chez 2 patients qui succombèrent à une récidive de la tamponade cardiaque. La péricardectomie totale semble être l'intervention de choix de la péricardite urémique car elle seule réalise un traitement définitif de cette affection. Le risque de tamponade cardiaque justifie un traitement chirurgical précoce dans ce groupe de malades graves.

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Presented at the 49th Annual Scientific Session of the American Heart Association, Miami Beach, Florida, November 15–18, 1976.     

Early pericardiectomy of acute purulent pericarditis]

The results of early pericardiectomy in 15 cases of acute purulent pericarditis were reported. 13 cases were followed up from 2 to 8 years, none of them developed chronic constrictive pericarditis. The operation is simple and can shorten the time of hospitalization following thorough debridement of the infected foci.     

Hemodynamic effect of the prone position during anesthesia

We studied 21 patients undergoing lumbar spinal surgery under halothane anesthesia on a convex saddle frame, in order to determine the hemodynamic effect of the prone position. A thermodilution pulmonary arterial catheter was placed in 14 patients (Group PA-1: n = 8; and Group PA-2: n = 6), and an inferior vena caval catheter in the remaining seven patients (Group IVC). Group PA-1 and Group IVC patients were placed in the prone position on a convex saddle frame. In the prone position, the cardiac index (CI) decreased significantly from 3.1 +/- 0.5 to 2.5 +/- 0.3 (l.min-1.m-2, mean +/- s.d., P less than 0.01) without accompanying significant changes in the other hemodynamic variables in Group PA-1. The postural change in Group IVC did not exert a significant effect on the inferior vena caval pressure. Group PA-2 were initially placed in the flat prone position on a flat saddle frame, which produced no significant changes in the hemodynamic variables. Then the convex curvature of the frame was adjusted to the grade appropriate for surgery, which produced a significant reduction in CI (from 2.9 +/- 0.3 to 2.4 +/- 0.4, P less than 0.05). We conclude that the prone position itself may not interfere with the circulatory function. The prone position using a convex saddle frame causes significant reductions in CI, but little change in the other hemodynamic variables.     

胸膜全肺并部分心包切除术后患者心律失常的预防护理

对34例胸膜全肺并部分心包切除术患者,术前予循环功能评估、呼吸功能训练、纠正水电解质酸碱代谢紊乱、改善营养状况等预防心律失常护理.结果 患者均顺利完成手术,术后发生心律失常10例,予动态心电监护、充分给氧、体位护理、疼痛护理、静脉输液管理等措施,有效纠正了心律失常,全部患者好转出院.     

Hemodynamic effect of carotid stenting and carotid endarterectomy

BACKGROUND: Carotid angioplasty with stent placement (CAS) may offer an alternative treatment to carotid endarterectomy (CEA). However, in contrast to CEA, which has been shown to normalize impaired cerebral hemodynamics, the effects of CAS remain unclear. To investigate alterations in cerebral hemodynamics, we prospectively studied patients undergoing CAS and compared them with a group of similar patients undergoing CEA. METHODS: Twenty-three patients undergoing CAS for recently symptomatic internal carotid artery (ICA) stenosis were prospectively studied. Volume flow in the ICAs and basilar artery (BA) were measured with magnetic resonance volume flow quantification before CAS and 1 month after. The results were compared with those in 13 similar patients undergoing CEA and 40 control subjects without ICA stenosis. RESULTS: After CAS, volume flow in the ipsilateral ICA increased from 114 +/- 17 to 231 +/- 17 mL/min (P < .001), and total volume flow (ICAs plus BA) increased from 495 +/- 24 to 552 +/- 28 mL/min (P < .05). No significant changes were seen in the contralateral ICA and BA after CAS. Total volume flow and flow in the stenosed ICA normalized after CAS compared with control subjects. Volume flow values similarly improved after CEA. CONCLUSIONS: CAS results in a normalization of impaired cerebral hemodynamics, as assessed by magnetic resonance volume flow measurements. The degree of improvement is similar to that seen after CEA.     

哌库溴铵对低血容量犬血流动力学的影响

成年杂种犬２４只，随机分为二组：低血容量模型组 ８只，低血容量实验组 １６只，采用 ＧｏｕｌｄＩｍ１０００电脑监测仪创伤性监测血流动力学指标，选用Ｄｅｓａｌ休克模型法制造低血容量模型，放血后，放血量几乎为犬总血量的５０％，两组犬血流动力学指标明显改变，心电图出现Ｔ波倒置，ＳＴ段水平下移缺血性改变。有此基础上，低血容量实验组给４０ｕｇ／ｋｇ的哌库溴铵，而低血容量模型组不给药，１小时内两组犬血流动力学指标无明显改变，心电图缺血性改变来见加重，两组犬各时间点血流动力学指标无明显差异。因此，哌库溴铵对低血容量犬血流动力学无明显影响，可考虑用于临床休克患者。     

Total robotic-enhanced pericardiectomy for effusive pericarditis

With the DaVinci Robot only recently in clinical use, limitations of video-assisted thoracoscopy could disappear due to Endo-Wrist features, tremor cancellation and three-dimensional view. This report describes the total endoscopic pericardiectomy successfully achieved with robotic assistance in a 50-year-old man suffering from effusive pericarditis.     

Mitral regurgitation after pericardiectomy for constrictive pericarditis.

We report a case of constrictive pericarditis in which trace mitral valve regurgitation was detected preoperatively and temporarily worsened after a pericardiectomy was performed. The early postoperative data suggested that the increased mobility of the lateral wall, in conjunction with an increase in the left ventricular volume, might be one of the causes of the perioperative mitral valve dysfunction. The mitral valve function returned to the preoperative baseline thirteen months after the pericardiectomy.     

心包剥脱术术前危险因素与转归分析

背景 心包剥脱术被证实是治疗慢性缩窄性心包炎的有效方法,但若干围术期危险因素影响术后患者短期及长期病死率. 目的 识别围术期危险因素有利于合理评估围术期风险,改善管理策略. 内容 从心包炎病因、心包钙化、心脏疾病相关因素、内环境因素、伴随疾病、手术相关因素等方面,分析导致患者术后短期及长期不良转归的危险因素. 趋向 由于当前的研究着眼于术前因素,将来关注术中及术后因素的研究可加深对该手术围术期危险因素的认识,进一步改善管理策略.