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Pericardial window: mechanisms of efficacy
J T Sugimoto1, A G Little, M K Ferguson
1Department of Surgery, University of Chicago, Illinois.
The Annals of Thoracic Surgery
|September 1, 1990
Summary
Pericardial window procedures achieve success through epicardial-pericardial fusion, not a persistent drainage pathway. Maintaining tube drainage until minimal output facilitates this inflammatory fusion for long-term relief from effusions.
Area of Science:
- Cardiology
- Thoracic Surgery
- Medical Physiology
Background:
- The exact mechanism by which pericardial window procedures alleviate pericardial effusions is not fully understood.
- The term 'window' suggests continuous drainage, but the underlying physiological process may differ.
Purpose of the Study:
- To investigate the mechanism of success for subxiphoid pericardial window procedures.
- To determine if success is due to a persistent drainage pathway or tissue fusion.
Main Methods:
- A subxiphoid pericardial window procedure was performed on 28 patients.
- Tube drainage was maintained until fluid output was minimal.
- Postoperative echocardiograms and autopsies (in 4 cases) were used to evaluate the pericardial space.
Main Results:
- No operative deaths occurred; 92.9% (26 of 28) achieved permanent relief from effusions.
- Echocardiograms showed pericardial/epicardial thickening and obliteration of the pericardial space post-procedure.
- Autopsies confirmed inflammatory fusion between the epicardium and pericardium.
Conclusions:
- The success of pericardial windows relies on inflammatory fusion of the epicardium to the pericardium, obliterating the potential space.
- This fusion, rather than a persistent window, is the key to long-term effusion relief.
- Maintaining tube decompression until minimal output is crucial for promoting this fusion.