Thoracoscopic pericardial window creation and thoracic duct ligation in neonates.
OBJECTIVE
We describe 2 newborn infants with persistent pericardial effusion treated with thoracoscopic pericardial window and thoracic duct ligation.


METHODS
Patient 1 was a premature female newborn who presented with severe cardiac anomalies, including dextrocardia. She was treated with pulmonary artery handing and pacemaker placement for complete cardiac block. Postoperatively, she developed pericarditis with persistent symptomatic pericardial effusion. She did not improve despite pericardial drain placement. She was treated with a thoracoscopic pericardial window. Patient 2 was a newborn male who presented with cardiac tamponade secondary to congenital chylopericardium. He did not respond to pericardial drain placement or medical management with fasting, total parenteral nutrition, and octreotide. He was treated with thoracoscopic pericardial window and thoracic duct ligation.


RESULTS
Patient 1 improved rapidly. The pericardial effusion disappeared. The chest tube was removed 5 days following surgery. She died 6 weeks later of a cardiac arrhythmia secondary to pacemaker failure. The pericardial effusion had resolved. Patient 2 responded to the pericardial window and thoracic duct ligation. He was discharged 10 days following the procedure.


CONCLUSIONS
Thoracoscopy provides an excellent approach to the pericardium. Pericardial windows and biopsy can be safely performed with this approach. The thoracic duct can be easily identified and ligated even in small babies. Recovery can be fast with minimal postoperative discomfort. Cosmetic results are excellent and length of hospitalization is minimized.
Stringel
Gustavo
G
Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, New York 10595, USA.
Ouzounian
Steven P
SP
Napoleon
Lori
L
Permut
Lester C
LC
Golombek
Sergio G
SG
D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008026:Ligation; D008297:Male; D010490:Pericardial Effusion / Q000601:surgery*; D010491:Pericardial Window Techniques; D013897:Thoracic Duct / Q000601:surgery*; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome