Clinical Application of Parasternal Mediastinotomy

Calvin, James W.; Stemmer, Edward A.; Steedman, Robert A.; Connolly, John E.

doi:10.1001/archsurg.1971.01350040084016

Cited by 17 publications

(5 citation statements)

References 6 publications

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“…A method not significantly different from ours was first described by Calvin in 1971. He suggested the parasternal mediastinotomy as a possible clinical application for pericardial fenestration [20]. We have found one article of a case report using the same approach for solving the problem of tension pneumo-pericardium [21] and another about pericardioscopy performed with the same armamentarium [22].…”

Section: Discussionmentioning

confidence: 99%

Mediastinoscope-controlled parasternal fenestration of the pericardium: definitive surgical palliation of malignant pericardial effusion

Tóth¹,

Szücs²,

Molnár

2012

J Cardiothorac Surg

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Background The tumorous infiltration or carcinosis of the pericardium could cause pericardial effusion in up to one-third of cases of malignancy, thus potentially interfere with the otherwise desirable oncological treatment. The existing surgical methods for the management of pericardial fluid are well-established but are not without limitations in the symptomatic relief of malignant pericardial effusion (MPE). The recurrence rate ranges between 43 and 69% after pericardiocentesis and 9 to 16% after pericardial drainage. The desire to overcome relative limitations of the existing methods led us to explore an alternative approach. Methods The standard armamentarium of the Carlens collar mediastinoscopy procedure was utilized in a Chamberlain parasternal approach of the pericardial sac. The laterality of approach was decided based upon the pleural involvement, as tumor-free pericardiopleural reflection is required. A pericardio-pleural window at least 3 cm in diameter was created. From January 2000 to December 2009, 22 cases were operated on with mediastinoscope-controlled parasternal fenestration (MCPF). Considering the type of the primary tumor, there were 11 lung cancer, 6 breast cancers, 2 haematologic malignancies and in 3 patients the origin of malignancy could not be verified. Results There were no operative deaths. We lost one patient (4.5%) in the postoperative hospital period. All of the surviving patients had a minimum of 2 months of symptom-free survival. We detected transient recurrence of MPE in one patient (4.5%) 14 days after the MCPF, which disappeared spontaneously after 24 hours. Conclusion The MCPF offers a real alternative in certain cases of pericardial effusion. We recommend this method especially for the definitive surgical palliation of MPE.

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Section: Discussionmentioning

confidence: 99%

Mediastinoscope-controlled parasternal fenestration of the pericardium: definitive surgical palliation of malignant pericardial effusion

Tóth¹,

Szücs²,

Molnár

2012

J Cardiothorac Surg

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“…The indications for diagnostic anterior mediastinotomy were well documented by McNeill and Chamberlain (1966). Calvin et al (1971) reported further use of the procedure in minor operations on the heart, including implantation of pacemakers, pericardial and myocardial biopsy, and pericardial drainage.…”

Section: Discussionmentioning

confidence: 99%

Anterior mediastinotomy

Evans

Hall

Harrison

1973

Thorax

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The indications and techniques for performing the operation of anterior mediastinotomy are described. In the years 1966-71, 116 anterior mediastinotomies were done. The results of these are presented.In 36 patients the operation was done to provide a histological diagnosis in benign conditions. In 51 patients, with probable carcinoma but normal bronchoscopy, mediastinotomy was done to establish a diagnosis and assess operability; 43 had involved mediastinal nodes proven on histology. In a further 29 patients, with positive bronchoscopic biopsies, mediastinotomy was done to assess operability alone. In all, 14 patients (17-5%) were judged suitable for thoracotomy. Of these, nine had operable disease while five were found to be inoperable.The incidence of complications of the operation was low (11%). These were mostly minor, There were no deaths. Most patients, after anterior mediastinotomy alone, were fit for discharge 48 to 72 hours after the operation.The value of an operation that provides both diagnosis and assessment of mediastinum, lung, and pleura is discussed. The operation of anterior mediastinotomy is compared with mediastinoscopy and, in our opinion, the superiority of the former is demonstrated.In this unit the presence of malignant nodes in the mediastinum is a contraindication to radical surgery for carcinoma of the lung. The place of anterior mediastinotomy to obtain this information and to make diagnoses in obscure lung, pleural, and mediastinal pathology is discussed. It is not proposed to enter the arguments for or against radical or supraradical surgery but rather, with the above criteria in mind, to assess the merits of a minor diagnostic procedure for the prevention of unnecessary thoracotomy with its associated morbidity and discomfort for the patient.In the presence of diagnosed carcinoma of the bronchus, with suspect mediastinal involvement on chest radiography, patients were selected for anterior mediastinotomy only if their general condition and / or bronchoscopic appearance were favourable for lung resection. Eighty-one patients, in the review period, underwent lung resection without mediastinotomy as they had no suggestion of mediastinal involvement on the chest film. Where there was doubt as to the diagnosis mediastinotomy was performed for diagnosis and for assessment for thoracotomy.Carlens (1959)

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“…They also described a parasternal mediastinoscopy method in 1971 [14]. That same year, Calvin et al [15] reported the results of 152 parasternal mediastinoscopies. Pericardium fenestration was performed in two of these cases using this approach.…”

Section: After Larrey and Romeromentioning

confidence: 99%