engleski

Thoracoscopic decompression of pericardial space by creation of pericardial window

This work describes minimally invasive method in the treatment of patients with compressive form of pericardial disease, which was accepted and routinely used at our Clinic since 1997. The obvious principal in the management of patients with pericardial disease is decompression of the pericardial space to allow adequate ventricular filling during diastole. Decompression can be accomplished in several ways, including pericardiocentesis, creating of pericardial window, or pericardiectomy. This open surgery method requires left thoracotomy, median sternotomy or subxiphoid approach to the pericardium. Thoracoscopic creation of pericardial window drains liquid collection from the pericardial space of the pleural, where it is reabsorbed of much easier removed by pleural punction. A total of 8 thoracoscopic surgeries for pericardial disease were performed at our clinic during 1997 and 1998. The group consisted of 5 men and 3 women with a mean age of 56 years. In 3 patients pericardial effusion followed chronic renal disease. Three patients suffered from pulmonary carcinoma of the larynx and one from the acute lymphoblastic leukemia. In all cases the diagnosis was established preoperativelly. In eight patients with previously treated malignant disease and chronic renal failure with elevations of the blood urea nitrogen, cardiologist, for decompression of pericardial space indicated thoracoscopic creation of the pericardial window. In all eight of them a good visibility of the surgical field and a satisfactory visualisation of the pericard were obtained. All the patients bore the procedure very well so that a conversion was not necessary in any of them. Following opening of the pericardium an effusion of mean volume 550 ml was evacuated, serous in 7 cases and blood stained in one (patient with chronic renal failure). The fact that there was no intraoperative or postoperative mortality in our series of patients, who were in the fairly advanced stages of a malignant disease or chronic renal disease, sholud be highlighted as a major advantage of this surgical procedure over the classical thoracotomy

pericardial disease; thoracoscopic decompression; pericardial window

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