Pericardial-peritoneal window: A novel palliative treatment for malignant and recurrent cardiac tamponade

Kallianpur, Ashwin A; Samra, Shivpreet Singh; Nimbran, Vinod; Gupta, Rakesh; Akkarappatty, Cherian; Gupta, Nidhi; Gupta, Gaurav

doi:10.4103/0973-1075.116710

Cited by 4 publications

(6 citation statements)

References 10 publications

(16 reference statements)

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“…Through a subxiphoid approach, pericardiocentesis involves inserting a long 18-22 gauge needle attached to a syringe between the xiphisternum and left costal margin, directed toward the left shoulder with continual aspiration. In patients with MPE, a pericardial window may be preferred due to a lower risk of recurrence (18)(19)(20). However, in patients with lung cancer and MPE, studies have shown that the pericardial window may be associated with worse overall survival when compared to use in non-lung cancer patients (21).…”

Section: Discussionmentioning

confidence: 99%

Would the Addition of Immunotherapy Impact the Prognosis of Patients With Malignant Pericardial Effusion?

et al. 2022

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Pericardial effusion is a common finding in advanced-stage lung cancer. The presence of malignant cells or drainage of exudate effusion in the pericardial space may cause symptoms of dyspnea, pleuritic chest pain, and syncope. In addition to the difficulty physicians face in the detection and diagnosis of malignant pericardial effusion, treatment may be challenging considering the cancer prognosis and cardiovascular stability of the patient. Despite the availability of several treatment modalities for malignant pericardial effusion, including chemotherapy and surgery, patients with lung cancer historically present with poor prognoses. In addition to lung adenocarcinoma with malignant pericardial effusion, this case was complicated by COVID-19 and malignancy-associated obstructive pneumonia. We present a case of a 64-year-old woman with advanced non-small cell lung carcinoma (NSCLC) with malignant pericardial effusion who, despite testing positive for COVID-19 and having obstructive pneumonia, had favorable outcomes following systemic therapy with combined chemo-immunotherapy.

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Section: Discussionmentioning

confidence: 99%

Would the Addition of Immunotherapy Impact the Prognosis of Patients With Malignant Pericardial Effusion?

et al. 2022

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“…Respecting the Halsted's principles, refinements in technique and increased surgical experience can potentially decrease incidence and severity of these complications (Jackson and others 1999, Moores 2016). Perioperative complications are far less frequent after thoracoscopy than after conventional thoracotomy (Jackson and others 1999, Walsh and others 1999, Crumbaker and others 2010, Mayhew and others 2012, Atencia and others 2013, Kallianpur and others 2013). On the other hand, the long‐term outcome in dogs with idiopathic pericardial effusion treated with pericardial window technique was significantly shorter, compared with that of dogs treated by subtotal pericardiectomy during open thoracotomy (Case and others 2013).…”

Section: Discussionmentioning

confidence: 99%

“…In human medicine, a transdiaphragmatic approach to the heart is indicated for intraoperative cardiopulmonary resuscitation (Schnüriger and others 2014), evaluation of occult cardiac injury (Grewal and others 1995) and the creation of a pericardial-peritoneal window (Kallianpur and others 2013). …”

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confidence: 99%

“…A transdiaphragmatic approach can alternatively be used to expose the heart and is commonly used for epicardial pacemaker placement in dogs and cats (Fingeroth and Birchard 1986, Visser and others 2013). In human medicine, a transdiaphragmatic approach to the heart is indicated for intraoperative cardiopulmonary resuscitation (Schnüriger and others 2014), evaluation of occult cardiac injury (Grewal and others 1995) and the creation of a pericardial‐peritoneal window (Kallianpur and others 2013).…”

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confidence: 99%

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Transdiaphragmatic pericardiectomy in dogs

et al. 2017

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In patients with recurrent pericardial effusions, pericardiectomy is indicated. The purpose of this study was to describe a transdiaphragmatic approach for subtotal pericardiectomy in dogs and to evaluate its feasibility. In total, 20 canine cadavers weighing less than 10 kg (group S) and 20 weighing more than 20 kg (group L) were used. Within each group, half underwent a subphrenic pericardiectomy via an intercostal approach and half via a transdiaphragmatic approach. For each approach and within each weight group, the percentage of resected pericardium was calculated and compared. Additionally, a case series of nine consecutive client-owned dogs that underwent a transdiaphragmatic pericardiectomy for pericardial effusion was reported. Exposure of pericardium and associated phrenic nerves was excellent in cadavers and clinical patients. In group S, the percentage of resected pericardium was not significantly different between the two approaches. In group L, on the other hand, the percentage of resected pericardium was lower with the transdiaphragmatic approach compared with the intercostal approach (P=0.001). In the clinical patients, no intraoperative complications were encountered and no recurrence of pericardial effusion was seen. Subtotal pericardiectomy via a transdiaphragmatic approach is straightforward and a safe surgical procedure to obtain permanent pericardial drainage in small and large breed dogs.

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“…Malignant pericardial effusions, which can lead to life-threatening cardiac tamponade, require urgent treatment. However, management of patients with malignant pericardial effusion poses a therapeutic challenge due to recurrences (2,3).…”

Section: Introductionmentioning

confidence: 99%

Pericardioperitoneal window creation for recurrent pericardial tamponade: A case report and literature review

EKİM,

EKİM

2024

Preprint

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Background: As a result of the increased life expectancy of cancer patients due to developing effective treatments applied, the incidence of secondary patterns such as malignant pericardial effusion has increased. Therefore, pericardial effusions leading to cardiac tamponade have been becoming an increasingly common emergency in medical practice. Although positive results are obtained with echocardiography-guided pericardiocentesis or percutaneous catheter drainage in pericardial effusions causing tamponade, the effusion may recur in some malignant cases. In the management of such patients, it is desirable to provide permanent drainage by opening a pericardial window instead of performing frequent pericardiocentesis. Case Presentation: A 62-year-old male patient with tamponade was admitted to our hospital. The clinical picture was corrected by pericardiocentesis accompanied by echocardiography. However, due to rapid fluid accumulation that required pericardiocentesis every other day, he was referred to the cardiovascular surgery department for surgical drainage. The patient clinically improved after the subxiphoid pericardial window was created. However, when symptoms of tamponade developed again 24 hours after the chest tube was removed, a pericardioperitoneal window was opened with a subxiphoidal approach. There were no recurrences of effusion for three months until the patient died of malignancy. Conclusion: In patients who have undergone pleurodesis or who are not suitable for general anesthesia due to their hemodynamic conditions, the best surgical procedure to prevent recurrent effusions causing tamponade is to create a pericardioperitoneal window under local anesthesia.

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Pericardial-peritoneal window: A novel palliative treatment for malignant and recurrent cardiac tamponade

Cited by 4 publications

References 10 publications

Would the Addition of Immunotherapy Impact the Prognosis of Patients With Malignant Pericardial Effusion?

Would the Addition of Immunotherapy Impact the Prognosis of Patients With Malignant Pericardial Effusion?

Transdiaphragmatic pericardiectomy in dogs

Pericardioperitoneal window creation for recurrent pericardial tamponade: A case report and literature review

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