Creation Of Pericardial Window Research Articles

Secure Closure of the Tracheal Incision After Natural Orifice Transluminal Endoscopic Surgery With a Surgical Sealant (CoSeal)

To evaluate the effectiveness of surgical sealant (CoSeal) in sealing the tracheal assess sites after transtracheal thoracoscopy. Two dogs underwent transtracheal thoracic exploration and pericardial window creation. The thoracic cavity was approached with flexible bronchoscope through a 9-mm tracheal incision. The pericardial window was performed with a needle knife via the working channel of the bronchoscope, and the tracheal assess site was closed with CoSeal using a rubber catheter. The integrity of tracheal healing was evaluated under positive pressure ventilation. Transtracheal creation of pericardial window and closure of tracheal incision with CoSeal was successfully performed in both dogs. There was no evidence of air leaks from the chest tube during positive pressure ventilation. Autopsy revealed no injury to the mediastinum and intrathoracic structure. Endoscopic closure of tracheal access site of NOTES with CoSeal appears to be a feasible technique.

Feasibility of Endoscopic Transoral Thoracic Surgical Lung Biopsy and Pericardial Window Creation

The thoracic cavity approach for natural orifice transluminal endoscopic surgery (NOTES) is technically challenging. The aim of this study was to evaluate the feasibility of a transoral endoscopic technique for a surgical lung biopsy and pericardial window creation Under general anesthesia, a 12 mm incision was made over the vestibulum oris region. Under video guidance, a homemade metallic tube was introduced through the incision, extending along the pre-tracheal space to the substernal space with blunt dissection technique, and used as the entrance into the thoracic cavity. A surgical lung biopsy and a pericardial window creation were performed in 12 canines, using the transoral NOTES technique. The transoral endoscopic surgical lung biopsy and pericardial window creation were successfully completed in 11 of the 12 canines. Intraoperative bleeding and death from an injury to the pulmonary hilum developed in one animal during the electrosurgical excision of lung tissue. Transoral surgical lung biopsy and pericardial window creation in canine models is technically feasible and can be used as a novel experimental platform for studies of NOTES for intra-thoracic surgery.

Natural orifice transluminal endoscopic surgery: A transtracheal approach for the thoracic cavity in a live canine model

The present study aimed to evaluate the performance of transtracheal thoracic exploration and pericardial window creation in a canine survival model. Transthoracic exploration was performed in 14 dogs. Under general anesthesia, after an incision in the right lateral wall of the middle-lower portion of the trachea was made, a 9-mm metal tube was advanced into the thoracic cavity. For thoracic cavity exploration and pericardial window creation, a flexible bronchoscope was introduced through the metal tube into the thoracic cavity. After thoracoscopy, a Dumon stent (Novatech, Grasse, France) was used to cover the tracheal incision site and facilitate healing. Animals were evaluated by endoscopy 1 and 2 weeks later. Animals were humanely killed, and necropsy was performed 2 weeks after the transtracheal natural orifice transluminal endoscopic surgery. Fourteen dogs underwent transtracheal thoracic exploration lasting for an average of 110 minutes (range, 80-150), with 3 perioperative deaths. At 2 weeks after pericardial window creation, endoscopy revealed normal healing of the tracheal incision sites in all 11 surviving animals. Necropsy on the 11 animals at 2 weeks showed 9 adhesions around the pericardial window and 5 adhesions around the tracheal incision region. No mediastinitis or abscesses could be identified. Transtracheal thoracic exploration is technically feasible. Increasing surgical experience together with improvement in endoscopic techniques will further facilitate the development of natural orifice transluminal endoscopic surgery for thoracic diseases.

Effective closure of a tracheal incision by BioGlue in natural orifice transluminal endoscopic surgery performed for thoracic exploration

There are few reports on the application of natural orifice transluminal endoscopic surgery (NOTES) for thoracic cavity procedures. The most important limitation to the development of NOTES is the lack of an effective endoscopic entrance (wound) closure device. The present study evaluated a novel method of wound closure that involves the use of BioGlue (Cryolife, Kennesaw, GA). This method has clinical significance because it avoids the need of a second operation for wound closure device removal. The study, approved by the review board of Chang Gung Memorial Hospital, had 2 parts: (1) to evaluate the integrity of tracheal wound repair using BioGlue in an explanted tracheal specimen and (2) to evaluate the effectiveness of BioGlue in tracheal wound closures in animals subjected to transtracheal thoracic exploration and pericardial window creation.

Transient Ischaemic Dilation on Tc99m Adenosine Myocardial Perfusion Imaging is not due to Left Ventricular Cavity Dilation or Stunning: Comparison of Echocardiography and Myocardial Perfusion Imaging

tuberculous (2%), sarcoid (2%) andunknown (20%).Cytologywas positive in 22%of all patients tested and 94%were exudates. Procedural success was 100% with no major complications or mortality. Mean total fluid drained was 553ml with extended catheter drainage used for a mean duration of 2 (range 1–4) days. Significant recurrences were noted in 8%. Definitive therapy was chemotherapy in 29% and creation of a surgical pericardial window in 11% of patients. Conclusion:CT fluoroscopy is a safe and effective strategy for pericardiocentesis with low complication rates. It is particularly useful in high risk patients with coagulopathy and when available should be considered a first line technique in all patients that are hemodynamically stable. doi:10.1016/j.hlc.2009.05.095

Laparoscopic transabdominal pericardial window

Creation of a transabdominal transdiaphragmatic pericardial window for life-threatening recurrent pericardial effusion has proved to be a safe minimally invasive technique. By inducing adequate pericardial sac decompression while avoiding single-lung ventilation and thoracic drainage in severely ill patients, it provides anatomopathologic diagnosis and can direct further therapeutic measures. The transabdominal approach improves postoperative recovery dramatically by limiting postoperative pain and prevents sometimes invalidating intercostal neuralgia. Transabdominal pericardial sac fenestration should be part of the armamentarium used by every minimally invasive surgeon.

Pericardial Effusion and Tamponade.

Pericardial effusion may occur as a result of a variety of clinical conditions, including viral, bacterial, or fungal infections and inflammatory, postinflammatory, autoreactive, and neoplastic processes. More common causes of pericardial effusion and tamponade include malignancy, renal failure, viral and bacterial infectious processes, radiation, aortic dissection, and hypothyroidism. It can also occur after trauma or acute myocardial infarction (as in postpericardiotomy syndrome following cardiac or thoracic surgery) or as an idiopathic pericardial effusion. Although pericardial effusion is common in patients with connective tissue disease, cardiac tamponade is rare. Among medical patients, malignant disease is the most common cause of pericardial effusion with tamponade. Table 1 shows the causes of pericardial tamponade. The effusion fluid may be serous, suppurative, hemorrhagic, or serosanguineous. The pericardial fluid can be a transudate (typically occurring in patients with congestive heart failure) or an exudate. The latter type, which contains a high concentration of proteins and fibrin, can occur with any type of pericarditis, severe infections, or malignancy. Once the diagnosis of pericardial effusion has been made, it is important to determine whether the effusion is creating significant hemodynamic compromise. Asymptomatic patients without hemodynamic compromise, even with large pericardial effusions, do not need to be treated with pericardiocentesis unless there is a need for fluid analysis for diagnostic purposes (eg, in acute bacterial pericarditis, tuberculosis, and neoplasias). The diagnosis of pericardial effusion/tamponade relies on a strong clinical suspicion and is confirmed by echocardiography or other pericardial imaging modalities. Alternatively, when the diagnosis of cardiac tamponade is made, there is a need for emergency drainage of pericardial fluid by pericardiocentesis or surgery to relieve the hemodynamic compromise. Following pericardiocentesis, it is necessary to prevent recurrence of tamponade. Intrapericardial injection of sclerosing agents, surgical pericardiotomy, and percutaneous balloon pericardial window creation are techniques used to prevent reaccumulation of pericardial fluid and recurrence of cardiac tamponade.

Thoracoscopic pericardial window and penetrating cardiac trauma.

Between September of 1991 and February of 1996, 108 patients with penetrating wounds near the heart, and with no obvious signs of cardiac injury, underwent the creation of a diagnostic thoracoscopic pericardial window to rule out cardiac injury. In 33 patients (30.6%), the procedure identified hemopericardium. Sensitivity for the procedure was 100%, specificity 96%, and accuracy 97%. There were no deaths and no complications due to the procedure. The thoracoscopic pericardial window has proved to be a precise, rapid, and safe method for the diagnosis of heart wounds in patients with no clear signs or symptoms, and it also allows the evaluation of other thoracic injuries and the evacuation of hemothorax when present. We recommend this procedure as the standard diagnostic approach for cardiac injuries in patients in stable condition.

Percutaneous balloon pericardiotomy for the treatment of large, nonmalignant pericardial effusions in children: Immediate and medium‐term results

To evaluate the safety and efficacy of pericardial window creation by percutaneous balloon dilation in children with recurrent, symptomatic, nonmalignant pericardial effusion, 6 boys and 4 girls, age 5–12 yr, underwent the procedure using the subxiphoid approach. The procedure was successful in 9 patients. There was one case with rupture of the balloon and entrapment of its distal part within the pericardium. During follow-up (mean 14.6 mo) there was reaccumulation of fluid only in the patient in whom rupture of the balloon had occurred. No other complications were noted. Thus, percutaneous balloon pericardiotomy appears to be a safe and effective technique for the creation of a pericardial window in children with nonmalignant pericardial effusions, and may be used as an alternative to surgical window creation. Cathet Cardiovasc Diagn 40:97–100, 1997 © 1997 Wiley-Liss, Inc.

Percutaneous balloon pericardiotomy for the treatment of large, nonmalignant pericardial effusions in children: immediate and medium-term results.

To evaluate the safety and efficacy of pericardial window creation by percutaneous balloon dilation in children with recurrent, symptomatic, nonmalignant pericardial effusion, 6 boys and 4 girls, age 5-12 yr, underwent the procedure using the subxiphoid approach. The procedure was successful in 9 patients. There was one case with rupture of the balloon and entrapment of its distal part within the pericardium. During follow-up (mean 14.6 mo) there was reaccumulation of fluid only in the patient in whom rupture of the balloon had occurred. No other complications were noted. Thus, percutaneous balloon pericardiotomy appears to be a safe and effective technique for the creation of a pericardial window in children with nonmalignant pericardial effusions, and may be used as an alternative to surgical window creation.

Percutaneous balloon pericardiotomy for management of cardiac tamponade in a patient with lung cancer and large pericardial effusion: Kouvaras G, Polydorou A, Hatziantoniou G. Cardiac Catheterization Laboratory, General State Hospital, Piraeus St Panteleimon. Acta Cardiol 1994;49:549–553

We describe the case of a 32-year-old man with lung cancer involving the pericardium on which we performed pericardiotomy, using a balloon dilating catheter, to create a non-surgical pericardial window. For the percutaneous creation of pericardial window we advanced into the pericardium by subxiphoid approach a 0.035 inch guide wire through a 7f. pig-tail catheter. Subsequently a 22 mm diameter, 4 cm long balloon dilating catheter was advanced to the parietal pericardium and inflated for about 60 seconds until a tear in the pericardium was formed. We believe that percutaneous balloon pericardiotomy is helpful in the management of large pericardial effusions particularly in patients with malignancies and poor condition.

Mechanism of pericardial window creation by balloon pericardiotomy

Surgical creation of a pericardial window has been the standard procedure for relieving symptoms of patients with recurrent pericardial effusion due to pericardial metastasis. 1 Recent preliminary reports indicated that percutaneous balloon pericardiotomy was a safe and efficacious alternative to surgical pericardial window for the treatment of refractory pericardial effusion. 2,3 The present in vitro study is designed to evaluate the mechanism of this nonsurgical creation of pericardial window using the Inoue balloon catheter.

A prospective trial of subxiphoid pericardiotomy in the diagnosis and treatment of large pericardial effusion. A follow-up report.

This study was designed to determine the cause of large pericardial effusions and evaluate the efficacy of subxiphoid pericardiotomy. Despite great advances in the techniques used to diagnose pericardial effusions, much controversy remains concerning their cause and the optimal treatment of these effusions. In a prospective consecutive case series, 57 patients underwent a thorough preoperative evaluation followed by a subxiphoid pericardiotomy. All tissue and fluid was exhaustively evaluated. Postoperatively, all patients were followed for a least 1 year. Surgery was performed under local anesthesia in 77% of patients, and the complications of surgery were minimal. Pericardial tissue and fluid established or aided in establishing a diagnosis in 81% of patients. Infection and malignancy were the leading causes; the condition in only 4 patients remained undiagnosed. Follow-up revealed recurrent effusion in nine (16%) patients, but only five (9%) required further surgery. The mortality rate at 30 days was 12%, and at 1 year, it was 37%. Fourteen of the 21 deaths occurred in patients with malignancies. These data show that the cause of most large pericardial effusions can be determined by a thorough evaluation accompanied by subxiphoid pericardiotomy. In addition, subxiphoid pericardial biopsy and window creation is safe and effective in the treatment of these effusions.

Subxiphoid Pericardial Window in Patients with Suspected Traumatic Pericardial Tamponade

The technique, indications, and results of subxiphoid pericardial window in penetrating chest wounds with suspected traumatic pericardial tamponade are reported. The classic signs of pericardial tamponade (elevated central venous pressure, muffled heart sounds, and paradoxical pulse) are unreliable in an emergency situation. Chest roentgenograms and electrocardiograms are of little diagnostic value. Pericar-dicentesis was either falsely positive or negative in 50% of our patients. Therefore, unexplainedhigh central venous pressure and hypotension were considered to be pericardial tamponade until disproved by the results of a subxiphoid pericardial window. There were 4 negative and 46 positive findings of tamponade in 50 consecutive patients with suspected traumatic pericardial tamponade who underwent creation of a subxiphoid pericardial window. There were no deaths or complications from the procedure. The early use of subxiphoid pericardial window has been a major factor in reducing our mortality rate from penetrating heart wounds to 12% overall, and 8% in the past three years.

Pleural pericardial window for palliation of cardiac tamponade due to cancer.

Cardiac tamponade due to metastatic cancer may be successfully palliated by creation of a pleural pericardial window. Four patients with malignant cardiac tamponade underwent surgery at the University of Colorado in a 12-month period with no mortality. A normal cardiac and mediastinal silhouette was achieved in all 4 patients, 2 of whom had postoperative radiation therapy. A pleural pericardial window was established in 3 patients, resulting in prompt relief of tamponade. A fifth patient, who refused pleural pericardial window, is also reported. This patient died of pericardial tamponade in 10 days, in spite of repeated pericardiocenteses.