title: Video-assisted thoracoscopic pericardial window for diagnosis and management of pericardial effusions.
abstract: BACKGROUND
  Video-assisted thoracoscopy with the creation of a pericardial window is a noninvasive method of pericardial drainage. It also allows an excellent view of both the pleural cavity and pericardium and the precise selection of biopsy sites. We review our 3-year experience with this technique.
  
  
  METHODS
  Between January 2001 and February 2004, 18 patients (10 men, 8 women; mean age 57 years) with echocardiographically diagnosed pericardial effusion underwent video-assisted thoracoscopy at our center. Pericardial windows were created under general anesthesia and single-lung ventilation using 2 to 3 trocars. Mean operating time was 46 minutes. A right thoracic approach was used in 16 patients and a left thoracic approach in 2.
  
  
  RESULTS
  Microbiology and virology cultures of the pericardial fluid were negative. Histologic findings were compatible with tuberculosis in 2 cases and granulocytic sarcoma, infiltrating breast carcinoma, and infiltrating nonsmall cell carcinoma in 1 case each. In the remaining patients, the histologic diagnosis was chronic or subacute nonspecific pericarditis. Talc pleurodesis was performed in 3 patients for concomitant malignant pleural effusion. In 4 patients, the pericardial effusion occurred secondary to cardiac surgery; 3 were receiving anticoagulants after valve replacement, and 1 had a heart transplant. There were no complications of the thoracoscopy technique.
  
  
  CONCLUSIONS
  Video-assisted thoracoscopic fenestration is an effective technique for pericardial drainage and biopsy. Apart from its diagnostic value, it allows the physician to fashion a pleuropericardial window for effective drainage while avoiding the complications of classic surgical procedures. Concomitant pleural and pulmonary disorders may be managed simultaneously.
authors.affiliation: Department of Cardiothoracic Surgery, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, Israel.
authors.forename: Georgios P
authors.initials: GP
authors.lastname: Georghiou
authors.forename: Alon
authors.initials: A
authors.lastname: Stamler
authors.forename: Erez
authors.initials: E
authors.lastname: Sharoni
authors.forename: Suzana
authors.initials: S
authors.lastname: Fichman-Horn
authors.forename: Marius
authors.initials: M
authors.lastname: Berman
authors.forename: Bernardo A
authors.initials: BA
authors.lastname: Vidne
authors.forename: Milton
authors.initials: M
authors.lastname: Saute
mesh_terms: D000368:Aged; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D010491:Pericardial Window Techniques / Q000295:instrumentation*; D020775:Thoracic Surgery, Video-Assisted