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From January 1967 through November 1983, 66 patients with a previously established diagnosis of malignancy were treated for pericardial effusion by the creation of a pericardial window. The majority of the patients had malignancies of the breast or lung, or lymphoma. There were no deaths or major complications attributable to the operative procedures. The presence of malignant pericardial effusion is usually evidence of far-advanced disease and, therefore, the prognosis is poor. Seventeen patients (26%) were alive 1 or more years postoperatively and 33 patients (50%) died within 3 months of operation. Despite the grave prognosis, it is still our belief that malignant pericardial effusion should be treated aggressively by open surgical drainage so that continuation of therapy for the primary malignancy would be possible.

For trauma, the traditional approach to the proximal left subclavian artery is through a posterolateral thoracotomy. The purpose of this study was to evaluate the feasibility of accessing the proximal left subclavian artery through a partial sternotomy approach. Anatomical review of 52 subclavian arteries was performed on 52 randomly picked computed tomography (CT) scans of the thorax. The depth of the origin of the subclavian artery was measured from the lateral thoracic wall and from the sternum. It was noted that the distance from the sternum to the origin of the left subclavian artery was 4.71 cm as compared to the posterolateral wall, which was 8.87 cm. This is in contrast to the belief that the left subclavian artery is a posterior structure in the mediastinum. A subclavian artery aneurysm was repaired through the sternal approach and was noted to have an adequate exposure required for the procedure. This approach was necessitated owing to the fact that the patient had significant chronic obstructive pulmonary disease. From these data, the authors conclude that in elective circumstances it is easier and appropriate to use the partial sternotomy approach to access the proximal left subclavian artery, especially in patients who have reduced pulmonary function.

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