Thoracoscopic pericardial fenestration: diagnostic and therapeutic aspects.

Cantó, A.; Guijarro, Ricardo; Arnau, A.; Fernández-Centeno, A; Císcar, M A; Galbis, Jose M.; García-Vilanova, A

doi:10.1136/thx.48.11.1178

Cited by 28 publications

(7 citation statements)

References 10 publications

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“…Recently, pericardial fenestration by use of video-assisted thoracoscopy has been proposed in order to gain simultaneous pleuropericardial access and to treat loculated pericardial effusions under direct vision [3][4][5][6][9][10][11][12]. Our results support the view that this technique is well-suited for this purpose.…”

Section: Discussionsupporting

confidence: 77%

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Video-assisted thoracoscopic pericardial fenestration for loculated or recurrent effusions

Geissbühler

Leiser

Fuhrer

et al. 1998

European Journal of Cardio-Thoracic Surgery

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Section: Discussionsupporting

confidence: 77%

“…Tel. : +41 31 6322330; fax: +41 31 sufficient size with simultaneous assessment of concomitant pleural pathology [3][4][5][6][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Video-assisted thoracoscopic pericardial fenestration for loculated or recurrent effusions

Geissbühler

Leiser

Fuhrer

et al. 1998

European Journal of Cardio-Thoracic Surgery

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“…Our study indicates that the TPW for patients with PEs that are recurrent or difficult to drain percutaneously is an effective, safe procedure. Unlike pericardiocentesis, TPW drains PEs into the thoracic cavity through a pericardial window [ 1 , 2 , 4 ]. The effusion is then absorbed through the pleura.…”

Section: Discussionmentioning

confidence: 99%

“…A true window can be created by partial pericardiectomy, creating a passage that presumably allows longer-term drainage into an adjacent space, usually the pleural space [ 2 ]. Additionally, the TPW usually enables treatment while establishing a diagnosis by pericardiectomy [ 4 ], and it is less invasive than conventional thoracotomy. Despite these advantages, however, there are few published data regarding the outcome of TPW for PEs that are recurrent or difficult to drain.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of thoracoscopic pericardial window in patients with pericardial effusions: a single-center case series

Sakanoue

Hamakawa

Okubo

et al. 2016

J Cardiothorac Surg

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BackgroundPericardial effusion (PE) is a common finding in patients who had chronic cardiac failure, who had undergone cardiac surgery, or who had certain other benign and malignant diseases. PE ranges in severity from mild, asymptomatic effusions to cardiac tamponade. Although a thoracoscopic pericardial window (TPW) is a minimally invasive surgical option for patients with PE, there are few published data regarding the outcomes of TPW for PE. We investigated the contribution of the TPW to the treatment of PEs that are recurrent or difficult to drain percutaneously.MethodsWe conducted a retrospective chart review of the indications for TPW that included data on preoperative, intraoperative, and postoperative variables; morbidity; recurrence; and survival. Fourteen consecutive patients with PE that was recurrent or difficult to drain percutaneously and who underwent treatment with a TPW were enrolled in this study. Trocars for passage of the thoracoscope and surgical instruments were introduced through two or three incisions. Mini-thoracotomy was also performed in patients with hemopericardium and loculated fibrinous effusions. All patients were evaluated by face-to-face interviews, transthoracic echocardiography (TTE), and chest radiography 3–6 months after the TPW was obtained.ResultsThe mean age of the patients was 70 years (range 28–83 years). The operative time was 72.1 ± 29.5 min. Six patients had undergone open heart surgery during the month prior to their presentation with PE. No intraoperative or postoperative complications occurred, although PE had recurred in one patient. Two patients died of malignant disease several months after the TPW. The cardiothoracic ratio (determined on chest radiographs) and the ejection fraction ratio (determined using TTE) had improved at the 3- and 6-month follow-up evaluations (p < 0.0001 and p = 0.012, respectively). Some patients could discontinue diuretics after the procedure, as assessed by the cardiologist based on symptom alleviation, chest radiography, and TTE findings.ConclusionsFor patients with PEs that are recurrent or difficult to drain percutaneously, TPW is an effective, safe surgical approach in terms of cardiac function and radiological findings.

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“…However, constrictive pericarditis, pleural and pulmonary disorders and closure of the fenestration were reported and we need to follow her carefully. [6][7][8]…”

Section: Discussionmentioning

confidence: 99%

Massive intractable pericardial effusion in a patient with systemic lupus erythematosus treated successfully with pericardial fenestration alone

Kamata

Iwamoto

Aoki

et al. 2008

Lupus

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Systemic lupus erythematosus (SLE) is often complicated by pericarditis with effusion, which generally responds well to glucocorticoid. We report herein a Japanese patient with SLE who showed a sign of cardiac tamponade and severe chest and back pain because of massive intractable pericardial effusion. Pulse glucocorticoid and pulse cyclophosphamide gained marginal effects. Pericardial effusion accumulated again soon after ultrasound-guided pericardiocentesis and drainage. Pericardial fenestration performed surgically as a last resort, for draining pericardial fluid into the pleural space, was very effective, and only a much smaller amount of fluid was observed in the space thereafter in comparison with the volume before the surgery. Pathological examination of the retrieved pericardium unfolded intense hyperplasia of small vessels and capillaries. Levels of IL-6 and TNF-alpha in pericardial effusion were extremely higher than those in serum. Pericardial effusion with extensive capillary hyperplasia in SLE would be resistant to medical treatment and require surgical fenestration.

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Thoracoscopic pericardial fenestration: diagnostic and therapeutic aspects.

Cited by 28 publications

References 10 publications

Video-assisted thoracoscopic pericardial fenestration for loculated or recurrent effusions

Video-assisted thoracoscopic pericardial fenestration for loculated or recurrent effusions

Efficacy and safety of thoracoscopic pericardial window in patients with pericardial effusions: a single-center case series

Massive intractable pericardial effusion in a patient with systemic lupus erythematosus treated successfully with pericardial fenestration alone

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