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.
Yim
A P
AP
Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin.
Ho
J K
JK
D002305:Cardiac Tamponade / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008875:Middle Aged; D010490:Pericardial Effusion / Q000601:surgery*; D010492:Pericardiectomy / Q000379:methods*; D016896:Treatment Outcome; D014741:Video Recording; D014989:Xiphoid Bone