The Thoracic Surgery Scoring System (Thoracoscore) Accurately Predicts Hospital Mortality in Patients Undergoing Pericardial Window for Malignant Pericardial Effusion.

Malignant pericardial effusion with cardiac tamponade is a rare manifestation of metastatic gynecological cancer. A 35-year-old female was diagnosed with clear cell adenocarcinoma of the vagina. Four years after partial vaginectomy, she developed regional recurrence and was treated with surgical excision followed by platinum-based chemotherapy and radiation therapy. Six years later, the patient was diagnosed with lung metastases and received a combination adriamycin and platinum-based chemotherapy. Shortly after completing treatment, she presented with weakness and was found to be hypotensive on physical exam. Computed tomography scan confirmed a pericardial effusion with evidence of bilateral heart failure. She underwent an emergent pericardiocentesis and eventual pericardial window procedure. Metastatic adenocarcinoma of the vagina can present with malignant pericardial effusion with cardiac tamponade. Therefore, gynecologists and gynecological oncologists need to be familiar with the diagnosis and management of this disease process.

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Subxiphoid window drainage of pericardial effusion - study of 35 cases

University Heart Journal ◽

10.3329/uhj.v5i2.4558 ◽

1970 ◽

Vol 5 (2) ◽

pp. 71-74 ◽

Cited By ~ 1

Author(s):

Rezwanul Hoque ◽

Mostafa Nuruzzaman ◽

Sabrina Sharmin Husain ◽

Zerzina Rahman

Keyword(s):

Pericardial Effusion ◽

Thoracoscopic Surgery ◽

Exclusion Criteria ◽

Pericardial Window ◽

Echocardiographic Finding ◽

Malignant Pericardial Effusion ◽

Physical Findings ◽

Age Range ◽

Effusive Constrictive Pericarditis ◽

Video Assisted Thoracoscopic Surgery

Pericardial effusion defines the presence of an abnormal amount and/or character of fluid in the pericardial space. It can be acute or chronic and caused by a variety of local and systemic disorders, or it may be idiopathic. Pericardial effusion can be relieved by medical treatment, pericardiocentesis through a needle with or without echocardiographic guidance, or by surgical procedures, such as subxiphoid pericardial tube drainage, by creating a pericardial window through a left anterior thoracotomy, or by video assisted thoracoscopic surgery (VATS) Subxiphoid pericardial window drainages were done on 35 patients with symptomatic pericardial effusion in the Department of cardiac surgery, BSMMU, from February, 1995 through July, 2009, and were all included in this retrospective observational study. The inclusion criteria were an established diagnosis of pericardial effusion confirmed by history, physical findings and transthoracic echocardiography, hemodynamic alteration as evidenced by hypotension( systolic blood pressure < 90 mm of Hg), shortness of breath, echocardiographic finding of > 10 mm echo free space with/ without compression of heart, recurrence after pericardiocentesis, haemorrhagic or thick pericardial effusion and malignant pericardial effusion. The exclusion criteria were loculated or post surgical pericardial effusion, effusive constrictive pericarditis or where formal thoracotomy was applied for drainage of effusion. Patients were followed up at one month and three months following the drainage procedure. The age range was from 13 years to 70 years (Mean 47.86 ± SD 15.20 years), 19 (54.28%) were male, 16(45.72%) were female. The symptomatology varied but cardiac and respiratory decompression overwhelmed other symptoms. In this study tuberculosis is the most common cause of pericardial effusion, idiopathic and malignancies are other important causes. Subxiphoid window drainage is an effective process in relieving pericardial effusion and the reaccumulation rate is low. Key words: Subxiphoid window drainage; Surgical drainage of pericardial effusion; Pericardial effusion. DOI: 10.3329/uhj.v5i2.4558 University Heart Journal Vol.5(2) July 2009 pp.71-74

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Cardiac tamponade due to malignant pericardial effusion in breast cancer: A case report

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v9i1.28946 ◽

2016 ◽

Vol 9 (1) ◽

pp. 53

Author(s):

Sultan Mahmud ◽

Omar Sadeque Khan ◽

Md. Aftabuddin ◽

Asit Baran Adhikary

Keyword(s):

Breast Cancer ◽

Pericardial Effusion ◽

Cardiac Tamponade ◽

Duct Cell ◽

Pericardial Fluid ◽

Pericardial Window ◽

Severe Respiratory Distress ◽

Malignant Pericardial Effusion ◽

History Of ◽

Subxiphoid Pericardial Window

We present a case of 35 years old women who presented to our institution with a history of bilateral infiltrating duct cell carcinoma of breast, chest pain with heaviness, severe respiratory distress and hypotension. Echocardiography revealed massive pericardial effusion with features of cardiac tamponade. The patient was treated with urgent pericardiocentesis followed by subxiphoid pericardial window drainage of 500ml of haemorrhagic pericardial fluid. Cytological examination confirmed the previous suspicious of malignancy. The patient tolerated the procedure very well, immediate symptomatic relief was observed.

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Subxiphoidal pericardial ‘window’ in the management of malignant pericardial effusion

European Journal of Surgical Oncology ◽

10.1016/s0748-7983(95)97268-4 ◽

1995 ◽

Vol 21 (5) ◽

pp. 545-547 ◽

Cited By ~ 3

Author(s):

P.P. Vassilopoulos ◽

K. Nikolaidis ◽

E. Filopoulos ◽

J. Griniatsos ◽

A. Efremidou

Keyword(s):

Pericardial Effusion ◽

Pericardial Window ◽

Malignant Pericardial Effusion

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Incarcerated intrapericardial diaphragmatic hernia after laparoscopic pericardial window for malignant pericardial effusion

Journal of Clinical Images and Medical Case Reports ◽

10.52768/2766-7820/1300 ◽

2021 ◽

Vol 2 (5) ◽

Author(s):

Ekhlas S Bardisi ◽

◽

Luning Redmer ◽

Luk Verlaeckt ◽

Filip Vanrykel ◽

...

Keyword(s):

Pericardial Effusion ◽

Diaphragmatic Hernia ◽

Lung Ventilation ◽

Pericardial Tamponade ◽

Pericardial Window ◽

Malignant Pericardial Effusion ◽

Minimally Invasive Surgical ◽

Thoracic Drainage ◽

Treatment Measures ◽

Intrapericardial Diaphragmatic Hernia

Laparoscopic Pericardial Window (LPW) is a safe, minimally invasive surgical technique for treating pericardial effusion/tamponade. This technique allows adequate decompression and avoids single-lung ventilation and the need for thoracic drainage in severely ill patients; it also provides anatomopathological and microbiological diagnosis leading to treatment measures. An intrapericardial diaphragmatic hernia is among the rarest complications of this procedure. A 85-year-old man, who underwent LPW for pericardial tamponade, presented to the emergency department 12 days post-operative with bowel obstruction; CT scan showed an incarcerated hernia into the pericardial sac. Laparoscopic reduction and hernia repair were performed using a large-pore Mesh to allow further drainage of histologically proven malignant pericardial effusion. Keywords: pericardial tamponade; pericardial window; surgical drainage of pericardial effusion; intra-pericardial diaphragmatic hernia.

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Thoracoscore: Predicting risk of in-hospital mortality for patients undergoing pulmonary resection

Vojnosanitetski pregled ◽

10.2298/vsp160228333d ◽

2018 ◽

Vol 75 (3) ◽

pp. 297-300

Author(s):

Dejan Djuric ◽

Gorica Malisanovic ◽

Ljiljana Gvozdenovic

Keyword(s):

Thoracic Surgery ◽

Hospital Mortality ◽

Scoring System ◽

Risk Model ◽

Performance Status ◽

Clinical Excellence ◽

Risk Groups ◽

British Thoracic Society ◽

Multiple Variables ◽

American Society

Background/Aim. Thoracic surgery is in need of a widely recognized and dependable risk model which could pro-spectively make objective conclusions and retrospectively allow comparison of outcomes. Thoracoscore is the first model with multiple variables developed for predicting in-hospital mortality following pulmonary resections. It is integrated in the British Thoracic Society and National Institute of Health and Clinical Excellence guidelines. However, additional evaluation of Thoracoscore is considerably advised in order to demonstrate its validity and potentially make it a dependable tool for thoracic surgeons across the world. Our study assesses the accuracy of Thoracoscore scoring system in estimating in-hospital mortality in patients under-going pulmonary resections. Methods. Between September 2013 and October 2014 data were retrospectively collected on 196 patients operated on at the Thoracic Surgery Clinic, Institute of Pulmonary Diseases of Vojvodina. The procedures performed were: pneumonectomies, lobectomies and modified lobectomies (including bilobectomy and sleevelobectomy), Wedge resections and atypical resections. The Thoracoscore was calculated based on these nine variables: age, sex, American Society of Anaesthesiologists' (ASA) class, performance status classification, dyspnea score, priority of surgery, procedure class, diagnosis group and co-morbidities score. Results. Study included one hundred and ninety-six patients, average age of 62 ? 9 years, and 61% were males. Predicted mean in-hospital mortality was 3.6 ? 3.2% 95% confidence interval (CI) 3.16?4.06, and mean actual in-hospital mortality was 6/196 (3.1%) (95% CI 1.78?4.42). Patients who were > 65 years old contributed to 3/6 (50%) of in-hospital mortality, and 4/6 (67%)were males. Four of 6 (67%) patients underwent pneumonectomy due to malignant pathology. Thoracoscore was divided into 4 risk groups: low (0?3), moderate (3.1?5), high (5.1?8) and very high (> 8). The correlation between observed and expected mortality was 0.99, by category of risk. Old age, male gender and malignancy showed to be strong indicators of in-hospital mortality. Conclusion. At our department Thoracoscore presented with good performance and as a practical tool for predicting in-hospital mortality among patients undergoing lung resections. However, any risk scoring system needs further validation before implementation and outcomes must be compared to those of other programs.

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