A case of surgery applying a Denver shunt for intractable pericardial effusion*

We report our experience in the application of a Denver shunt as surgical treatment for intractable pericardial effusion. The patient was a 60-year-old woman who suffered from pericarditis accompanied by intractable pericardial effusion as complications of systemic lupus erythematosus. Pericardial fenestration with thoracoscopic assistance and a right pleuroperitoneal shunt using a Denver shunt were performed as surgical treatment. Postoperatively, the patient’s heart failure symptoms disappeared and her pericardial effusion was considerably reduced. The postoperative course was uneventful without recurrence after a 2-year follow-up period.

Proposal for name of surgical access-Substernal instead Subxiphoid for pericardial fenestration

Objective: Various surgical accesses for pericardial fenestration are described and used in the literature. Each of them has its advantages and disadvantages depending on the cause of the need for pericardial fenestration. Results: Operative and perioperative mortality has not been reported. Operative complications such as bleeding, injury to the coronary artery or myocardium have not occurred. Substernal access after resection of the xiphoid process is a safe and effective approach for surgical treatment of pericardial tamponade.

A Rare Case of Pericardial Effusion in a Patient with Silicosis

Silicosis is an occupational lung disorder caused by inhalation of silica dust. It not only causes respiratory disorders but also affects other organs. We report an extremely rare case of silicosis complicated by pericarditis in an 83-year-old male. He had been working as a coal miner and was diagnosed with silicosis at the age of 63. Because he had experienced repeated pericardial effusions, he was referred for a surgical pericardial biopsy to elucidate the cause of his repeated pericardial effusion and to perform pericardial fenestration. Thoracoscopic surgery was performed. The pericardium was resected, and a drain was placed in the left thoracic cavity. Histopathological examination revealed the pericardial degeneration due to silicosis, suggesting that pericarditis and pericardial effusion are related to silicosis. The operation was successful, and he experienced no recurrence of pericardial effusion at the 7-month follow-up.

Chronic Cardiac Tamponade Treatment in Cardiac Neoplasms

Among complications of malignant neoplasms of the heart, tumor exudative pericarditis requires emergency surgical measures with the development of chronic tamponade. At the frst stage, puncture drainage of the pericardial cavity is advisable. In case of a common tumor process and the impossibility of radical surgical treatment by the second stage, it is advisable to perform video assisted thoracoscopic pericardial fenestration with biopsy and pleurodesis, if necessary. This tactic improves the quality of life in patients and complies with modern standards of treatment of this disease.

INNOVATIVE METHOD OF PERICARDIAL FENESTRATION ASSOCIATED WITH UNDERLYING CHRONIC RECURRENT PERICARDITIS: CASE REPORT

Objectives - to illustrate the clinical follow-up of a patient with chronic recurrent pericarditis subjected to a pericardial fenestration performed in a new manner, with subxiphoidal pericardiotomy, pericardioscopy followed by trans-pericardial thoracoscopy. Material and methods. A 69-year-old woman with chronic recurrent pericarditis and the threat of cardiac tamponade was subjected to subxiphoidal pericardiotomy, pericardioscopy and subsequent transpericardial thoracoscopy forming the pericardial window and junctions with pleural and abdominal cavity. Results. The first special aspect of the presented case is the combination of access types and the usage of non-standard access to the pleural cavity; the second one is the combined formation of fistulae between the pericardial cavity and two other cavities - the left pleural and abdominal. The positive outcome of this operation was the bidirectional drainage of pericardial exudate, as well as the minimal postoperative pain syndrome due to the absence of transthoracic access. Conclusion. The positive clinical result in the early postoperative period and during the long term followup period, the absence of complications allows for the safety of the technique and the possibility of performing such surgical operations in patients with acute and chronic exudative pericarditis and the threat of cardiac tamponade.

Survival Following Video-Assisted Thoracic and Mini-Thoracotomy Pericardial Fenestration

Objective: Surgical pericardial fenestration (sPF) is more invasive than interventional pericardiocentesis (PC) and requires general anesthesia. Severe complications such as ventricular puncture and chamber lacerations are, however, reported in association with PC and not with sPF. Is survival after sPF only determined by nonsurgical factors? Methods: Between July 2000 and December 2015, data of all patients who had undergone sPF—either thoracoscopically or by anterior mini-thoracotomy—were investigated. The 2 techniques were analyzed retrospectively and the outcome (effectiveness, change in shock index) and the survival were assessed. Results: 32 patients underwent 33 sPF. One-half of the patients had a benign underlying disease; the other half suffered from a malignant tumor. Four procedures were performed thoracoscopically and 29 via mini-thoracotomy. Both techniques were hemodynamically effective (P < 0.0001) in increasing blood pressure and decreasing pulse rate). There was no death due to failure to control the pericardial effusion and no procedure related mortality. Of the 16 patients with benign underlying disease 14 (87.5%) are still alive. Two died due to reasons unrelated to the procedure or the underlying disease. All 16 patients (100%) with malignant underlying disease died due to tumor progression. Conclusions: In our patient cohort minimally invasive thoracic PF was safe and effective. The survival in our study was only related to the nature of the underlying disease. We conclude that sPF is an excellent procedure to treat pericardial effusions: both examined surgical techniques, thoracoscopic video assisted and access via mini-thoracotomy, were equally effective and safe.