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A Journal on Surgery

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Chirurgia 2004 February;17(1):19-22


language: English

Long-term results of videothoracoscopic pericardial fenestration for persistent or recurrent effusions

Cecere C., Fraioli G., Cicalese M., Maietta P., Liberti D.


Aim. A total of 27 patients with pericardial effusions previously treated by pericardiocentesis or by percutaneous catheter was selected to assess the validity of video-thoracoscopy pericardial fenestration (VTPF).
Methods. Echocardiography and CT-scan were used to document pericardial effusions, to detect concomitant pleural pathology and to determinate the side of videothoracoscopy. Echocardiographic examination was repeated 3 months after the operation in all patients.
Results. Twenty seven patients underwent VTPF. Fifteen patients (55%) were treated by percutaneous catheter drainage and balloon pericardiotomy, 2 (7%) by pericardiocentesis and 1 (4%) by subxyphoidal fenestration previously. Echocardiographic examination revealed loculated pericardial effusions in 10 patients (37%). CT-scan identified concomitant pleural disease in 14 patients (52%). Talc pleurodesis was performed in 7 (26%) patients with malignant pleural effusions. The mean videothoracoscopic time was 50 minutes (35-65). No complications were observed. Postoperative echocardiography showed a recurrence in 1 case (4%). Relief of symptoms was echieved in all patients. Echocardiography revealed another recurrence during a mean follow-up time of 48 months (range 14-90 months) in 18 of 19 patients with benign pericardial effusions. No recurrence was observed in patients treated with talc pleurodesis.
Conclusion. The conclusion is drawn that videothoracoscopic pericardial fenestration is an excellent treatment option for persistent or recurrent pericardial effusions previously treated by pericardiocentesis or by percutaneous catheter and for patients with additional pleural disease. The results are sustained in a long follow-up period.

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