Video-assisted subxiphoid pericardiectomy

We report a case of malignant pericardial effusion with chronic tamponade treated by video-assisted subxiphoid pericardiectomy in a 58-year-old female. The procedure was performed under local anesthesia through a 3.5-cm midline incision over the xiphoid process using a mediastinoscope, a 5-mm telescope connected to the video camera, and an endoscopic grasper and scissors. A large piece of pericardium (5 cm x 6 cm) over the right ventricle was excised. The patient obtained immediate relief and was discharged on the second postoperative day. Follow-up at 4 months showed no recurrence of effusion. Video assistance allows generous pericardiectomy, and as the rate of recurrence has been suggested to be directly related to the extent of resection, video-assisted subxiphoid pericardiectomy offers a theoretical advantage over the conventional approach, as more pericardium can be excised. We recommend that this technique receive further investigation.