Thoracoscopic Partial Pericardiectomy in 13 Dogs

Abstract

Thirteen dogs with cardiac tamponade resulting from pericardial effusion were prospectively evaluated to determine feasibility and outcome of thoracoscopic partial pericardiectomy. A lateral thoracoscopic approach allowed adequate exposure to remove a 4-to 5-cm-diameter section of pericardium in all dogs. Complete resolution of cardiac tamponade occurred in all dogs for which there was follow-up (11 dogs). Ten of 13 dogs (76.9%) had neoplastic pericardial effusion. One of these dogs remains alive at 220 days postoperatively and is asymptomatic. The mean survival of the remaining 9 patents with neoplastic effusion was 128 days (range, 14-544 days; median, 38 days). Three of 13 patients (23.1%) had idiopathic pericardial effusion. Two of these dogs remain alive at 585 and 1,250 days postoperatively. One dog with idiopathic pericardial effusion developed cardiomyopathy and was euthanized 18 days after the procedure. Results indicate that the procedure was technically successful in all dogs. No anesthetic complications occurred. Procedural complications included phrenic nerve transection (1 dog), lung laceration (l dog), and moderate intraoperative bleeding (1 dog). No adverse clinical manifestations of the complications were apparent. We conclude that thoracoscopic partial pericardiectomy is technically feasible and offers several advantages over conventional open thoracic surgical pericardiectomy. P ericardial effusion can result from many causes, 1 and may result in cardiac tamponade when the intraperi-cardial pressure rises sufficiently to affect cardiac function by compressing the heart and limiting diastolic filling. 2 Consequently, stroke volume, arterial pulse pressure, and venous return are significantly decreased and perfusion of vital tissues is impaired. The animal may die if intraperi-cardial pressure is not decreased. 2 Initial management of cardiac tamponade often includes pericardiocentesis. 3 In almost all cases caused by neoplasia and in 40-50% of the cases caused by idiopathic pericardial effusion, cardiac tamponade recurs following pericardio-centesis. 3 In these cases, a partial or total pericardiectomy performed through a lateral thoracotomy or median ster-notomy is often advocated for treatment. These techniques are expensive and have the potential for substantial post-operative complications. Problems with standard open tho-racic surgical procedures include postoperative pain, hy-poventilation, hypothermia, acid-base disturbances, shock, oliguria, and prolonged anesthesia time. 3,4 The purpose of this study was to investigate a less invasive technique for performing a partial pericardiectomy using thoracoscopy in the dog. Materials and Methods Dogs Thirteen dogs with pericardial effusion were referred to the Veterinary Specialty Hospital of San Diego from 1992 through 1996. Peri-cardial effusion with cardiac tamponade was confirmed with 2-dimensional echocardiography characterized by some degree of right atrial and/or right ventricular collapse. The presence or absence of a cardiac From the V...

Thoracoscopic pericardial window for management of pericardial effusion in 15 dogs

“…There are also other studies describing different approaches and techniques for thoracoscopic pericardiectomy (Jackson et al 1999, Dupré et al 2001, Mayhew et al 2009). In these studies, lateral or paraxiphoid approaches with one-lung ventilation were used (Jackson et al 1999;Mayhew et al 2009). One-lung ventilation has been shown to detrimentally affect gas exchange and haemodynamic function at least experimentally (Kudnig et al 2003).…”

“…Apart from phrenic nerve and wound complications, lung laceration and intraoperative bleeding have been described with thoracoscopy (Jackson et al 1999). In a recent study, fatal hypotension was reported in 2 of 36 cases undergoing thoracoscopic pericardiectomy (Case et al 2013).…”

“…The authors did not have major difficulties extracting the excised pericardial segment from the thoracic cavity and specimen-retrieval bags were not utilised in any case. If possible the pericardial segment was extracted through the Bussadori et al 1998, Sidley et al 2002 or thoracoscopic pericardiectomy (Jackson et al 1999, Dupré et al 2001, Mayhew et al 2009, Case et al 2013. Thoracoscopic pericardiectomy has an additional benefit of offering better visualisation than traditional open thoracotomy by improving illumination and magnification to previously inaccessible areas (Walton 2001).…”

“…Two thoracoscopic pericardiectomy approaches have been described. The lateral approach was first described using one-lung ventilation (Jackson et al 1999). For the alternative paraxiphoid approach, the animal is placed in dorsal recumbency and onelung ventilation can be performed (Mayhew et al 2009, Bauquier et al 2010).…”

Advances in Video-Assisted Thoracic Surgery, Thoracoscopy

“…2,3,6,7 With presumed idiopathic cases, a complete pericardioscopic evaluation is necessary to reduce the chance of a missed diagnosis and a larger pericardectomy is indicated. 2,8 Because masses are common on the right auricle and heart base ( Fig.…”