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Surgical Approaches in Minimally Invasive Cardiac Surgery
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
Cardiac injury: During pericardiotomy right atrial injury is not uncommon. The pericardiotomy should be performed after establishment of the CPB. The pacing wires should be in situ before the cross clamps are removed, or at least before coming off CPB. A superficial attachment or insertion is recommended, to avoid RV or RA injury at the time of removal.
Fever in Diseases of the Cardiovascular System
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
The diagnosis of cardiac tumors relies upon two-dimensional echocardiography and computerized tomography to demonstrate an intracardiac mass. Other techniques that have been employed include angiocardiography, radioisotopic scanning and magnetic resonance imaging. Occasionally the diagnosis of myxoma is established by the discovery of myxomatous tissue at embolectomy. A right atrial mass can be biopsied during transvenous catheterization. Pericardial masses may be examined histologically following pericardiotomy. Other tumors can be identified only after thoracotomy.
Thoracic trauma
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Scott M. Moore, Frederic M. Pieracci, Gregory J. Jurkovich
Subxiphoid pericardiotomy, also referred to as “pericardial window,” should be performed in the operating room under sterile conditions and adequate lighting. A 10 cm midline incision through skin and subcutaneous tissue is made overlying the xiphoid process, and the latter is dissected free so that it may be grasped with a Kocher clamp and retracted in a cephalad direction. Fatty tissue in the subxiphoid space can then be bluntly dissected along with the use of frequent digital palpation to direct the dissection toward the car- diac impulse. Once the pericardium is visualized, which is facilitated by placing the patient in reverse Trendelenburg position at this stage, it should be grasped firmly with two Allis clamps. A 1 cm longitudinal incision is then made between the clamps, with care taken to avoid inadvertent injury to the underlying epicardium. Immediate return of straw-colored pericardial fluid indicates the absence of blood and a negative window, whereas bloody effluent is a posi- tive result and mandates extension to a sternotomy for full exploration and cardiorrhaphy. Absence of any fluid fromthe pericardiotomy should raise suspicion of clotted blood within the pericardial sac, and should be investigated by insertion of a suction catheter. If a negative result is obtained and sternotomy is not required, the pericardiotomy is closed with several simple interrupted polyglactin sutures, followed by closure of the incision.
Acute purulent pericarditis treated conservatively with intrapericardial fibrinolysis and intrapericardial and systemic antibiotics
Published in Baylor University Medical Center Proceedings, 2021
Mahmoud Abdelnabi, Abdallah Almaghraby, Yehia Saleh, Alyaa El Sayed, Judy Rizk
Prompt treatment of purulent pericarditis is required due to its high morbidity and mortality. The management strategy includes pericardial drainage and empirical antibiotics. The best method for pericardial drainage of purulent pericarditis is still debated.8 Pericardiocentesis might result in poor drainage or loculations in the pericardial space due to the thick nature of the accumulated fluid. Subxiphoid pericardiotomy with a pericardial window usually allows more complete and permanent drainage than conventional pericardiocentesis and allows manual lysis of adhesions and loculations. Pericardiectomy can result in complete drainage and is required in patients with dense adhesions, loculated and thick purulent effusion, recurrent tamponade, persistent infection, and progression to constriction; however, it has higher morbidity and mortality than subxiphoid pericardiotomy.9–11 As soon as purulent pericarditis is suspected, intravenous empirical broad-spectrum antibiotics should be started until a specific pathogen is identified, and then a pathogen-directed antimicrobial is used. The duration of antibiotic therapy should be individualized until fever and clinical signs resolve but generally should continue for at least 3 weeks.3
Update on diagnosis and management of neoplastic pericardial disease
Published in Expert Review of Cardiovascular Therapy, 2020
Stefano Avondo, Alessandro Andreis, Matteo Casula, Massimo Imazio
Since pericardiocentesis alone is associated with a high relapse rate (60–100%) and sclerosing therapy has a variable success rate, some authors recommend pericardial window as the option with best long-term results, limiting pericardial effusion relapses and providing specimens for cyto-histological assessment [52]. This technique, which can be accomplished surgically or percutaneously (percutaneous balloon pericardiotomy – PBP) allows the drainage of the pericardial fluid into a larger cavity (i.e. pleura or peritoneum), activating, at the same time, a local inflammatory response responsible for pericardial adhesion. The possibility of cancer cells’ off-seeding should be considered. Petrella et al., in a study published in 2018, asserted that pericardial-peritoneal window is an effective method to resolve malignant pericardial effusion in patients with a favorable short-term prognosis, whereas pericardial drainage should be considered only for palliative purposes [47]. Most patients with symptomatic pericardial tumors have a short median survival time due to their underlying disease. Indeed, in the study by Swanson et al. on the effectiveness of PBP for malignant pericardial effusion, the overall median survival after intervention was only 56 days [53].
Postpericardiotomy syndrome after cardiac surgery
Published in Annals of Medicine, 2020
Joonas Lehto, Tuomas Kiviniemi
In the most persistent cases of pericardial effusion, pericardiectomy may be considered [15]. Fortunately, this is needed only in extremely rare cases [68]. Other possible interventional treatments include prolonged pericardial drainage, the aforementioned intrapericardial triamcinolone treatment, and pericardial window [15]. The pericardial window can be performed either by conventional heart surgery, by thoracoscopy, or by balloon pericardiotomy by inserting a deflated single catheter or double balloon catheters into the pericardial space [181]. If the surgery is performed, pericardiectomy is the procedure of choice, because pericardial window may not relieve loculated pericardial fluid or may close soon after being performed [15,59]. If the persistent PPS manifests as large, symptomatic pleural effusions continuing despite several thoracocenteses, thoracoscopy should be considered. At thoracoscopy, any fibrous tissue coating the visceral pleura should be removed and either the parietal pleura should be abraded or talc should be used to create a pleurodesis [182,183]. In addition, a single case report has been published of the use of indwelling pleural catheter for the recurrent pleural effusions secondary to PPS [184].