Thoracoscopic Pericardial Window Research Articles

Awake thoracoscopic pericardial window is safe and feasible

Awake thoracoscopic pericardial window is safe and feasible

Safety and feasibility of thoracoscopic pericardial window in recurrent pericardial effusion - A single-centre experience.

This study aimed to report the surgical outcomes and also evaluating the safety and feasibility of thoracoscopic pericardial window (PW) for recurrent pericardial effusion. This was a retrospective analysis of eight cases of recurrent pericardial effusion, managed by thoracoscopic method in a tertiary-level thoracic surgery centre over 5 years. A detailed analysis of all perioperative variables, including complications, was carried out. A total of eight patients underwent thoracoscopic PW during the study period. Males (87.5%) were predominant in the cohort. The median age was 54 years (range: 28-78 years). The median duration of symptoms was 2 months (range: 1-3 months). Tuberculosis (50%), malignancy (37.5%) and chronic kidney disease (12.5%) were the causes of recurrent effusion. All patients underwent thoracoscopic procedure with no conversions. The median operative time was 45 min (range: 40-70 min). The median effusion volume drained was 500 ± 100 ml. The median hospital stay was 3 days (range: 2-4 days) with no post-procedural complications. All the patients had complete resolution of symptoms. No recurrence was noted in the median follow-up period of 28 months (range: 6-60 months). Thoracoscopic PW is a safe and feasible minimally invasive option in the management of recurrent pericardial effusion in selected patients. Surgical fitness, haemodynamic status and estimated survival (in malignant effusion) should be considered before the procedure.

Evaluation of Thoracoscopic Pericardial Window Size and Execution Time in Dogs: Comparison of Two Surgical Approaches.

Simple SummaryThis canine prospective study was performed to statistically compare the surgery time and achieved windows size of two different thoracoscopic pericardiectomy techniques in dogs affected by pericardial effusion, using transdiaphragmatic paraxyphoid and monolateral intercostal approaches. The paraxifoid and the monolateral intercostal approaches showed a mean surgical time of 55 ± 20.08 (SD) minutes and 13.94 ± 4.61 (SD) minutes, and a mean pericardial window diameter of 4.23 ± 0.80 (SD) cm and 3.31 ± 0.43 (SD) cm, respectively. A significant correlation was observed between the dogs’ bodyweight and window size (r = 0.48; p = 0.04) for both surgical approaches, and between the dogs’ bodyweight and surgical time (r = 0.72; p = 0.0016) for monolateral intercostal approach. Our results provided useful information to help surgeons make the definitive choice of the surgical technique to treat the pericardial effusion.Pericardial effusion presents clinicians with a challenge when diagnosing the underlying cause and performing a prognosis. Different techniques have been suggested for canine thoracoscopic pericardiectomy with the creation of variable pericardial window size. The aim of this study was to statistically compare the surgical time and achieved window size of the paraxiphoid transdiaphragmatic and monolateral intercostal approaches. The paraxifoid and monolateral intercostal approaches showed a mean surgical time of 55 ± 20.08 (SD) minutes and 13.94 ± 4.61 (SD) minutes, and a mean pericardial window diameter of 4.23 ± 0.80 (SD) cm and 3.31 ± 0.43 (SD) cm, respectively. A significant correlation was observed between the dogs’ bodyweight and window size (r = 0.48; p = 0.04) for both surgical approaches, and between the dogs’ bodyweight and surgical time (r = 0.72; p = 0.0016) for monolateral intercostal approach. All treated dogs showed no clinical signs of recurrent cardiac tamponade during the follow-up. Our results provided useful information to help surgeons make the definitive choice of the surgical technique to treat the pericardial effusion.

Efficacy of uniportal video-assisted thoracoscopic pericardial window creation using two lung ventilation in chronic large pericardial effusions.

To demonstrate that two lung ventilation under general anaesthesia may also be safely performed to create pericardial window with uniportal video-assisted thoracoscopic surgery. The single-centre, retrospective, comparative study was conducted at Bulent Ecevit University, Zonguldak, Turkey, comprised data from March 2011 to March 2018 of patients with recurrent and/or with chronic large pericardial effusions unresponsive to medical therapy and/or to pericardiocentesis and who underwent pericardial window creation with uniportal video-assisted thoracoscopic surgery. Group 1 had data of patients in whom pericardial windows were created under general anaesthesia, while group 2 had patients with two lung ventilation. Parameters compared between the groups were gender, age, operation side, operation time amount of drainage, complication, recurrences and survival. Data was analysed using SPSS 19. Of the 20 patients, 9(45%) were males and 11(55%) were females. Group 1 had 14(70%) patients, while group 2 had 6(30%). The age of patients in group 2 was significantly higher than those in group 1 (p=0.041). There was no significant difference between the groups with respect to gender, amount of drainage, operation time and post-operative complications (p>0.05). There was no recurrence or mortality in either of the two groups. Pericardial window could be created safely with video-assisted thoracoscopic surgery under two lung ventilation for patients carrying high risk for one lung ventilation.

Comparison of early stage electrocardiographic, echocardiographic and histopathologic results of partial pericardiectomy and thoracoscopic pericardial window techniques in an animal model

This study aimed to compare early stage electrocardiographic (ECG), echocardiographic (ECHO) and histopathologic results of the pericardial surgery techniques. Partial pericardiectomy by lateral thoracotomy and thoracoscopic pericardial window techniques was performed under general anesthesia in goats (n=6), which were separated into two groups; partial pericardiectomy was performed in group I (GRI) (n=3) and thoracoscopic pericardial window was performed in group II (GRII) (n=3). ECG and ECHO examinations were performed pre- and postoperatively on days 1, 7 and 30. All experimental animals were sacrificed at the end of day 30 and macroscopic investigations were performed. Histopathological examinations were performed on the lung, visceral pleura, epicardium and myocardial tissues. ECG findings included sinus tachycardia, small complex QRS and T wave peak on day 1 in both groups., The left atrial and ventricular diameters as well as the stroke volume were lower on the 1st postoperative day in both groups. The stroke volume was lower on postoperative days 1 and 30 in GRII. The observed ejection fraction was lower in GRII and higher in GRI on postoperative day 30 compared with their baselines. Macroscopic and histopathological findings of the lung and heart tissues were more severe in GRI, but there was no meaningful variation in the epicardium or visceral pleura. There was no significant difference in the histopathological results between the groups. Although the thoracoscopic pericardial window technique seem less traumatic and better tolerated than partial pericardiectomy, our ECHO and histopathologic results indicate that both techniques can safely be performed by surgeons according to the pericardial disease indication.

Single-Port Thoracoscopic Pericardial Window under Local Anesthesia

There are numerous surgical approaches for the treatment of pericardial effusions but no clear consensus of best management. We present a 44-year-old woman with metastatic breast cancer presenting with a new 2-cm pericardial effusion on ultrasound. In light of the patient's palliative condition and the urgent need for chemotherapy, careful consideration was made for her surgical drainage of the pericardial effusion. Because of the patient's medical comorbidities, a general anesthetic was deemed not to be in the patient's best interest. Furthermore, the invasive subxiphoid or thoracotomy approach for a pericardial window would have risked delaying her much needed chemotherapy. A single-port thoracoscopic pericardial window was performed under light sedation, ventilating spontaneously on supplementary oxygen through nasal cannula only. The patient was positioned in a supine position, and a single 8-mm port was inserted into the left hemithorax at the 5th intercostal space, midaxillary line under local anesthetic, and a pericardial window made. This minimally invasive approach, without the need for intubation or ventilation, allowed for rapid relief of symptoms and discharge for the patient to begin her chemotherapy in a timely manner. By undergoing the procedure awake and through a single port, the patient was discharged after a short inpatient stay. This novel approach can be advocated for patients where a general anesthetic or invasive surgical procedure is not suitable in the treatment of their pericardial effusion.

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

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.

Positive video-assisted thoracoscopic pericardial window, management of a right ventricle stab wound with minimally invasive technique

Positive video-assisted thoracoscopic pericardial window, management of a right ventricle stab wound with minimally invasive technique

Epicardial Coronary Artery Compression Secondary to Pericardial Adhesions Demonstrated by Multi-Modality Imaging, and Treated by Coronary Stenting

A 42-year-old female presented with sudden onset severe left-sided chest pain radiating to the left arm while watching a movie at home. She was rushed to the hospital within 10 minutes. She was found having ST elevation myocardial infarction on ECG and ventricular fibrillation arrest 2 times requiring cardiac resuscitation and defibrillation. Retrospectively, the patient recalled some ill-defined episodes of chest pain with exercise in the past few months before the admission. Her past surgical history 20 years previous was significant for video-assisted thoracoscopic surgery and pericardial window for removal of large, nonhemorrhagic pericardial effusion of 1.2 L, which occurred ≈1 week after her chest wall injury from basketball. Bedside transthoracic echocardiography revealed mildly decreased left ventricular systolic ejection fraction of 40% to 45%, and pericardial thickening with small pericardial effusion. The patient underwent emergent cardiac catheterization and coronary …

Video-Assisted Thoracoscopic Pericardial Window in the Treatment of Pericardial Effusion: Report of Two Cases

A 54-year-old man had a history of subxiphoid pericardial window due to suspected tuberculous effusions. Seventeen years later, following chronic heart failure and implantation of a pacemaker, he again developed pericardial and pleural effusion, re- quiring repeated percutaneous pericardiocentesis, pleurocentesis and chest tube drainage. A 5×5-cm section of pericardium was successfully resected with video-assisted thoracic pericardial window. No recurrence of pericardial effusion has since been encountered during 36 months follow-up. An 85-year-old woman had a history of percutaneous pericardiocentesis and pleurocentesis due to chronic pericarditis. The effusion of unknown origin was refractory to medication and additional pericardiocentesis and percutaneous pericardial and chest tube drainage. A 4×4-cm section of pericardium was also success- fully resected. No recurrence of pericardial effusion has been seen during 8 months follow-up. Video-assisted thoracoscopic pericardial window is an effective procedure for treating intractable pericardial effusion. ACTA MEDICA NAGASAKIENSIA 57: 105-107, 2012

Thoracoscopic pericardial window for management of pericardial effusion in 15 dogs

To report short-term complications and long-term outcomes of thoracoscopic pericardial window for management of pericardial effusion in dogs. Retrospective study of dogs in which thoracoscopic pericardial window was performed using a three-cannula technique. Surgery time, complications, postoperative management, area of resected pericardium, histopathology results and outcome were evaluated. Diagnoses included dogs with idiopathic pericardial effusion (n = 10), cardiac mass (n = 4) and mesothelioma (n = 1). One case required conversion to sternotomy. Median thoracoscopic surgery time was 52 · 5 (range, 45-80) minutes. Complications occurred in four (26%) cases. Median time to discharge was one (range, 1-6) day. Of dogs with idiopathic pericardial effusion, one is alive at 150 days, one was lost to follow-up at 180 days while eight were euthanased of which five were for unrelated reasons. All dogs with neoplastic causes died or were euthanased because of their illness. Median survival time for dogs with idiopathic pericardial effusion (635 days; range, 70-1165) was significantly longer than that for dogs with neoplasia (30 days; range, 1-107). Thoracoscopic pericardial window is of low morbidity with short surgery and hospitalisation times. It provides good long-term control of idiopathic pericardial effusion but short-term palliation of clinical signs in dogs with neoplastic disease.

Feasibility of Transumbilical Surgical Lung Biopsy and Pericardial Window Creation

To date there are no practical platforms for performing natural orifice transluminal endoscopic surgery in the thoracic cavity. This study evaluates the feasibility of transumbilical thoracosopy for lung biopsy and pericardial window creation. Eleven dogs (6 in the nonsurvival group and 5 in the survival group) were used for this study. A homemade metallic tube was advanced into the abdominal cavity via a 12-mm umbilical incision. The metallic tube was advanced into the thoracic cavity through a subxyphoid diaphragmatic incision under video guidance. Access to the thoracic cavity was achieved by a flexible bronchoscope via the metallic tube. Surgical lung biopsy and pericardial window creation were performed using an electrocautery loop and needle knife. The animals were euthanized 20 minutes after the surgery was complete (nonsurvival group) or 14 days postsurgery (survival group) for necropsy evaluation. Eight pericardial window creations and 21 of 22 preplanned lung biopsies were completed in a median time of 72.18 minutes (range 50-105 minutes). One dog in the nonsurvival group died after tension pneumothorax due to postprocedure massive air leaks. In the survival group, the postoperative period was uneventful in all 5 dogs. Autopsies revealed no signs of vital organ injury and complete healing of the diaphragmatic incision occurred in all animals. The study demonstrated that transumbilical thoracoscopic surgical lung biopsy and pericardial window creation is feasible. The safety and efficacy of the transumbilical approach need to be verified by a more detailed survival study.

Primary idiopathic silent chylopericardium

Chylopericardium usually occurs secondary to trauma, cardiothoracic surgery, radiation therapy, or neoplasm of the mediastinum. Idiopathic chylopericardium is extremely rare. We report a case of primary chylopericardium in a 79-year-old male patient. Although pericardial window and thoracic duct ligation are the treatment of choice, the patient has been doing well for six months since video-assisted thoracoscopic pericardial window.

Outcome evaluation of a thoracoscopic pericardial window procedure or subtotal pericardectomy via thoracotomy for the treatment of pericardial effusion in dogs

To evaluate the disease-free interval (DFI) and median survival time (MST) in dogs with idiopathic and neoplastic pericardial effusion surgically treated by a thoracoscopic pericardial window procedure or subtotal pericardectomy via thoracotomy and to compare DFI and MST in dogs with and without a mass on preoperative echocardiography that underwent either surgical technique. Retrospective cohort study. 58 dogs with pericardial effusion. Medical records between 1985 and 2010 were evaluated. Dogs were included in the study if they had confirmed pericardial effusion and underwent a thoracoscopic pericardial window procedure or subtotal pericardectomy via thoracotomy. Clinical signs of dogs at initial evaluation were similar, with the exception of lethargy, between dogs treated by subtotal pericardectomy via thoracotomy or the pericardial window procedure. Dogs with idiopathic pericardial effusion that underwent the thoracoscopic pericardial window procedure had significantly shorter DFI and MST than did those treated by subtotal pericardectomy via thoracotomy. For neoplastic pericardial effusion, DFI and MST were not significantly different between dogs treated with either surgical technique. Dogs with idiopathic pericardial effusion treated with a subtotal pericardectomy via thoracotomy had a significantly longer DFI and MST, compared with dogs treated by the thoracoscopic pericardial window procedure. This difference in outcome may be related to inaccuracy of the initial diagnosis or ineffectiveness of the pericardial window to palliate the signs of idiopathic pericardial effusion long term.

Comparison of VATS and thoracotomy in treatment of patients with pericardial effusion

Background: In this study we evaluated the importance of videoassisted thoracoscopic surgery (VATS) in the daily surgical practice by comparing the clinical results of patients with pericardial effusions who underwent classical anterior thoracotomy with thoracoscopic pericardial window. We also compared and discussed the potential advantages and possible weaknesses of thoracoscopic surgery versus the classical techniques with data available from the literature. Methods: Between January 2006 and December 2009, 94 patients diagnosed with pericardial effusion and/or tamponade who did not respond to previous medical treatments or who had a recurrence after multiple pericardiosynthesis procedures underwent surgical partial pericardial resection using surgical methods. Of these 94 patients 50 were operated on using pericardiectomy with VATS and 44 patients were operated on via anterolateral thoracotomy. These cases were evaluated with respect to age and gender distribution, etiology, operation type, operation time, quality and amount of the drained pericardial fluid, duration of intensive care unit (ICU) stay, chest tube drainage, duration of hospitalization, pathological diagnosis, complications, recurrence, cost, morbidity and mortality. Results: Significant differences were found in patients with or without malignancy. In malignant cases; no statistically significant differences were found with respect to age, gender, recurrence, operation times, or amount of drainage by the surgical technique (p>0.05). Statistically significant differences were found in favor of VATS with respect to duration of ICU stay, duration of hospitalization, drain extraction time and costs of the surgical technique (p0.05). Statistically significant differences were found in favor of VATS with respect to duration of hospitalization and drain extraction time by the surgical technique in this patients (p

The pericardial window: is a video-assisted thoracoscopy approach better than a surgical approach?

The approach to the pericardial window in patients with pericardial effusion (PE) remains undefined as to whether a surgical (transthoracic or subxiphoid) or a thoracoscopic pericardial window is the optimal operative approach to PE. We hypothesized that the window into the pleural space created by the thoracoscopy might improve the outcome. We conducted a prospective study between September 2007 and October 2009. All patients with PE diagnosed by echocardiography who attended the Cardiothoracic Department in King Fahd Hospital are included in this study. They were 30 patients (18 males, 12 females aged 44±1.22years). Patients were subdivided into two groups. Group A, 15 patients underwent the surgical (transthoracic or subxiphoid) procedure and Group B, 15 patients underwent the video-assisted thoracoscopy procedure. Preoperative, intraoperative and postoperative variables, morbidity, recurrence, and survival were compared in both groups. Preoperative variables were well-matched for age, sex, preoperative tamponade, echocardiographical characteristics and co-morbidities between both groups. No recurrence of effusion was observed in the two groups. Operative time was statistically highly significant (P<0.001); it was longer in Group B. There was no intraoperative complication in both groups. There was no postoperative complication in both groups except one case of superficial wound infection in Group A. There was no significance difference between both groups as regard duration of chest tube drainage and length of hospital stay. There was no in-hospital mortality in both groups. Pericardial window by video-assisted thoracoscopy is an effective technique for pericardial drainage and biopsy. Apart from its diagnostic value, it allows the physician to fashion a pleuropericardial window for effective drainage while avoiding the complications of classic surgical procedures.

Video-assisted thoracoscopic pericardial window for penetrating cardiac trauma

To report our experience with thoracoscopic pericardial window (TPW) for occult penetrating cardiac injury. During the study period (1 January - 31 December 2000), a small group of haemodynamically stable patients with anterior left-sided praecordial wounds were selected for TPW. All patients underwent general anaesthesia with double-lumen intubation and collapse of the left lung. A rigid laparoscope was inserted through a 2 cm incision in the 5th intercostal space in the anterior axillary line. Another 3 cm incision was made in the fourth intercostal space over the cardiac silhouette. Conventional instruments were used to grasp and open the pericardium. Any myocardial injury identified was an indication to proceed to sternotomy. In the absence of a myocardial injury and bleeding, the procedure was terminated and considered therapeutic. Seventy-one patients with suspected penetrating cardiac injuries were seen. TPW was successfully completed in 13 patients. All were men, with a mean age of 29.8 (range 19 - 38) years. Ten and 3 patients sustained stab and gunshot wounds, respectively. The mean revised trauma score was 7.84. Ultrasound was performed in 12 patients; the results were equivocal for 2 patients, and positive for an effusion in 4 patients. Haemopericardium was found in 3 patients, 2 of whom proceeded to sternotomy. No cardiac injury was found in 1, a left ventricular contusion was identified in the second, and the third patient had no further procedure after good video-thoracoscopic visualisation of the anterior myocardium revealed no injury. In another patient, pericardial bruising was evident without any haemopericardium. The mean operative time was 13.4 (range 10 - 15) minutes, with a mean hospital stay of 5.4 (range 3 - 8) days. There were no complications. The use of a double-lumen endotracheal tube increased the cost of TPW by 23% when compared with subxiphoid pericardial window (SPW). TPW is a feasible, although in our setting not cost-effective, diagnostic option for occult penetrating cardiac injuries.

Comparative Study of Subxiphoid Versus Video-Thoracoscopic Pericardial “Window”

It remains undefined whether surgical subxiphoid drainage or thoracoscopic pericardial "window" is the optimal operative approach to pericardial effusion. We hypothesized that the true window into the pleural space created by the latter might improve the duration of freedom from recurrent effusion. We conducted a retrospective chart review of indications, preoperative and intraoperative variables, morbidity, recurrence, and survival. Fifty-six patients underwent the subxiphoid procedure and 15 underwent the thoracoscopic procedure. Echocardiographic evidence of tamponade was present before 8 of 10 thoracoscopic procedures (80%) and 43 of 56 subxiphoid procedures (81%) for which descriptions of hemodynamics were available. In addition, non-pericardial procedures were performed in 10 (67%) and 18 (32%) patients, respectively (p = 0.020). Anesthesia time was longer at thoracoscopy (117.1 +/- 32.4 vs 81.1 +/- 25.5 minutes; p < 0.001). Procedural morbidity was higher after thoracoscopy (4 [27%] vs 1 [2%]; p = 0.006), but was generally minor. Hospital mortality tended to be higher after the subxiphoid procedure (7 [13%] vs 0 [0%]; p = 0.332), but none of the deaths was procedure-related. Follow-up was complete for 65 patients (92%). Recurrence occurred in 1 thoracoscopy patient (8%) and 5 subxiphoid patients (10%) (p = 1.000). Mean time to recurrence by Kaplan-Meier analysis trends were longer after thoracoscopy (36.1 vs 11.4 months; p = 0.16), and multivariate analysis identified the thoracoscopic approach as an independent predictor of freedom from recurrence (relative risk, 0.41; p = 0.014). Operative time and minor procedural morbidity are higher with thoracoscopic pericardial window, but long-term control of effusion seemed to be better than after subxiphoid surgical drainage.

Comparative Study of Subxiphoid Versus Video-thoracoscopic Pericardial “Window”

PURPOSE: When operation is indicated for the management of pericardial effusion, options include subxiphoid drainage (SXD) and thoracoscopic pericardial window (TPW), but it remains undefined which of these approaches is optimal. TPW creates a true “window” into the pleural space (unlike SXD) and permits the performance of simultaneous intra-pleural procedures, but it requires intercostal incisions, double-lumen intubation, and unilateral pulmonary collapse. We retrospectively reviewed our experience with TPW and SXW at the University of Pennsylvania Health System from 1992 to 2003 to compare indications, hospital course, and outcomes.

Delayed Hemopericardium After Penetrating Chest Trauma: Thoracoscopic Pericardial Window as a Therapeutic Option

A 41-year-old male developed a hemothorax after sustaining a stab wound in the right chest. The patient was managed conservatively with thoracostomy tube drainage for 3 days and was subsequently discharged home. Two weeks later the patient returned to the hospital with pleuritic chest pain and shortness of breath. Imaging studies revealed a right-sided pleural effusion and an enlarged cardiac silhouette, which was consistent with pericardial effusion as per ultrasonography. Thoracoscopic exploration revealed an enlarged heart, that following pericardiotomy drained 400 mL of frank blood. Subsequently, cardiac contractility improved, and no further bleeding was evident.