Thoracoscopic partial pericardiectomy in the diagnosis and management of pericardial effusion |
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Authors: | R Robles A Piñero J A Luján J A Fernández J A Torralba F Acosta M Villegas P Parrilla |
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Institution: | (1) Servicio de Cirugía general y del A. Digestivo, ``Virgen de la Arrixaca' University Hospital, 30120, El Palmar, Murcia, Spain, ES;(2) Servicio de Anestesiología y Reanimación, ``Virgen de la Arrixaca' University Hospital, 30120, El Palmar, Murcia, Spain, ES;(3) Servicio de Cardiología, ``Virgen de la Arrixaca' University Hospital, 30120, El Palmar, Murcia, Spain, ES |
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Abstract: | Background: An effort was made to present our experience with thoracoscopy in the diagnosis and management of pericardial effusions.
Methods: Twenty-two partial pericardiectomies were performed with the thoracoscopic approach in patients with pericardial effusions,
the etiology of which was uremic (n= 7), neoplastic (n= 8), idiopathic (n= 5), septicemia (n= 1), and postpericardiotomy (n= 1). All cases had grade III-IV/IV radiological cardiomegaly and ultrasonographic confirmation of the effusion. We found
hemodynamic compromise in 17 patients. The operation, requiring the insertion of three trocars, enabled us to remove a large
part (approximately 6 × 10 cm) of the left anterolateral side of the pericardium and aspirate the effusion contents for diagnostic
and therapeutic purposes.
Results: In five cases we found coexisting pleural effusions. The pericardial effusion had a mean volume of 817 ml, which was serous
in 11 cases, hematic in six, serohematic in four, and purulent in one. Cytology of the pericardial effusion was positive for
neoplasia in four cases (one pulmonary neoplasia, two breast carcinomas, and one lymphoma). We observed conversion to grade
I/IV cardiomegaly in 16 cases and a return to normality in the other six, with the absence of ultrasonographic effusion in
all cases. There was no recurrence during the mean follow-up period of 20.5 months (range: 2–47).
Conclusions: The thoracoscopic management of pericardial effusions is a simple and effective technique that allows us to create a large
pericardial window that drains the effusion definitively, determines its etiology, and explores and treats coexisting pleural
lesions, all without recurrences.
Received: 30 May 1996/Accepted: 27 August 1996 |
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Keywords: | : Pericardial effusions — Pericardial window — Partial pericardiectomy — Thoracoscopy — Video-assisted thoracoscopic surgery |
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