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Stephen R. Hazelrigg
Michael J. Mack
Rodney J. Landreneau
Tea E. Acuff
Paul E. Seifert
James E. Auer
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Ann Thorac Surg 1993;56:792-795
© 1993 The Society of Thoracic Surgeons

Articles

Thoracoscopic pericardiectomy for effusive pericardial disease

Stephen R. Hazelrigg, MD*,a,b,c, Michael J. Mack, MDa,b,c, Rodney J. Landreneau, MDa,b,c, Tea E. Acuff, MDa,b,c, Paul E. Seifert, MDa,b,c, James E. Auer, MDa,b,c

a Southern Illinois University, Springfield, Illinois USA
b Humana Hospital, Dallas, Texas USA
c University of Pittsburgh, Pittsburgh, Pennsylvania USA

* Address reprint requests to Dr Hazelrigg, Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, PO Box 19230, Springfield, IL 62794-9230.

Thoracoscopic techniques were used to perform a pericardiectomy in 35 patients with purely effusive pericardial disease after medical management and pericardioceniesis had failed to be effective. There were no intraoperative complications and postoperative complications were few. Two cases of dysrhythmia and 2 cases of pneumonia occurred postoperatively. Malignancy was identified as the cause in 18 patients and there were benign causes in the remaining 17. The hospital stay in the group with benign effusions was 4.6 days. There were no recurrences of pericardial effusions and no constrictive changes developed during a mean follow-up of 9 months. Fourteen (40%) patients had pleural or pulmonary abnormalities that were managed simultaneously thoracoscopically. These abnormalities included 2 pleural masses, 2 pulmonary nodules, and 12 pleural effusions. In 8 instances, the pericardiectomy was performed from the right pleural cavity in order to address the pleural or pulmonary problem. Thoracoscopic pericardial resection has proved safe and effective. It allows a wider pericardial resection than that usually permitted by the subxiphoid route, and should lessen the pain and the number of pulmonary complications, compared with open thoracotomy. An additional advantage is that it allows the visualization and management of simultaneous pleural and pulmonary abnormalities.




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