Related Experiment Videos
Video-assisted thoracoscopic pericardial fenestration for loculated or recurrent effusions
K Geissbühler1, A Leiser, J Fuhrer
1Department of Thoracic and Cardiovascular Surgery, Inselspital, University of Bern, Switzerland.
Summary
Video-assisted thoracoscopic pericardial fenestration effectively treats loculated pericardial effusions, even after prior treatments. This minimally invasive approach is safe and provides symptom relief for patients with complex effusions and concurrent pleural disease.
Area of Science:
- Cardiothoracic Surgery
- Minimally Invasive Procedures
- Pericardial Diseases
Background:
- Loculated pericardial effusions present diagnostic and therapeutic challenges.
- Previous treatments like percutaneous drainage may fail or be insufficient.
- Concurrent pleural disease can complicate management.
Purpose of the Study:
- To prospectively assess the validity of video-assisted thoracoscopic pericardial fenestration.
- To evaluate its efficacy in loculated effusions, including those with prior interventions.
- To determine its safety in patients with concurrent pleural pathology.
Main Methods:
- Prospective assessment of 24 patients undergoing thoracoscopic pericardial fenestration.
- Inclusion criteria: echocardiographically confirmed effusions needing diagnosis/symptom relief, or recurrent effusions post-percutaneous treatment.
- Pre-operative CT scans for pleural pathology; follow-up via clinical and echocardiographic examination.
Main Results:
- 11 patients (54%) had prior percutaneous treatments.
- 18 patients (72%) had loculated effusions.
- All patients achieved symptom relief; one recurrence (4%) at 3 months.
- Two recurrences (one non-malignant) noted at longer follow-up.
- No recurrences in six patients who underwent talc pleurodesis for malignant pleural effusion.
Conclusions:
- Video-assisted thoracoscopic pericardial fenestration is a safe and effective treatment for loculated pericardial effusions.
- It is beneficial for patients with a history of failed percutaneous drainage.
- The procedure is also suitable for patients with coexisting pleural diseases, especially when combined with pleurodesis.