Pericardial window: Mechanisms of efficacy

Sugimoto, Jeffrey T.; Little, Alex G.; Ferguson, Mark K.; Borow, Kenneth M.; Vallera, Dino; Staszak, Victoria M.; Weinert, Lynn

doi:10.1016/0003-4975(90)90491-n

Cited by 74 publications

(27 citation statements)

References 14 publications

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“…This contrasts with the tendency for clots to form in the drainage tubes when the traditional pathway is used. However, at postoperative day 10, there was one case of moderate effusion in the PW group, in which the pericardium was diffusely adherent to the epicardium by fibrinous adhesions; this resulted in the occlusion of the window itself, as described by Sugimoto et al 12 Compared with those aged 70 years, patients aged >70 years in the PW group needed longer ventilation assistance time. The pericardial window technique damages the negative pressure and closed characteristics of the pleural cavity and leads to alveolar collapse, or even atelectasis.…”

Section: Discussionmentioning

confidence: 92%

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Does posterior pericardial window technique prevent pericardial tamponade after cardiac surgery?

et al. 2014

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Objective: To investigate the efficacy of the intraoperative posterior pericardial window technique in preventing pericardial tamponade following open heart surgery. Patients and methods: Adult patients undergoing coronary and/or valve surgery were randomly divided into a control (traditional) or a pericardial window (PW) technique group. Pre-, intra-, peri-and postoperative clinical data were collected prospectively, including incidence of pericardial tamponade, cardiac arrest, drainage volume, ventilation assistance time and moderateto-large pericardial effusion. Results: In total, 458 patients were included: 230 controls and 228 in the PW group. The incidence of pericardial tamponade in the PW group was significantly lower than in controls. Cardiac arrest occurred in one patient (0.4%) in the PW group and five (2.2%) controls; this difference was not statistically significant. Moderate-to-large pericardial effusion after drainage extubation and newonset atrial fibrillation were significantly more common in controls than in the PW group. After stratification by age ( 70 versus >70 years), there was no between-group difference in duration of endotracheal intubation, although in the PW group, after removal of the tracheal cannula, duration of noninvasive positive pressure ventilation was significantly longer in older patients. Conclusions: The pericardial window procedure did not increase the rate or severity of procedure-related complications. This simple technique significantly decreased the incidence of postoperative pericardial tamponade and new-onset atrial fibrillation.

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Section: Discussionmentioning

confidence: 92%

“…As a result, we have investigated a novel drainage approach, the pericardial window technique, 12 to achieve a free passage between the limited pericardial cavity and the larger pleural cavity. Theoretically, this manoeuvre facilitates the transmission of pressure from the pericardial cavity to the pleural space below.…”

Section: Introductionmentioning

confidence: 99%

Does posterior pericardial window technique prevent pericardial tamponade after cardiac surgery?

et al. 2014

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“…Las opciones quirúrgicas tradicionales, como la ventana pericárdica por vía subxifoidea, por toracotomía antero-lateral y postero-lateral o por toracoscopia, la aplicación de agentes que producen esclerosis en el pericardio, la instalación temporal de un catéter de drenaje en el saco pericárdico y la pericardiocentesis guiada por imágenes, requieren de un agudo criterio oncológico, habilidad quirúrgica y conocimiento de la fisiología cardiopulmonar [22][23][24] .…”

Section: Principios Del Tratamiento Del Derrame Pericárdico En Pacienunclassified

Manejo del derrame pericárdico en el paciente con cáncer

et al. 2017

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“…The efficacy of this approach may be due, not only to the creation of a persistent communication through which fluid is drained, but to the inflammatory process that promotes adhesion between parietal and visceral pericardium, as confirmed by a small autopsy study [73] . In a prospective study from Duke University, surgical subxiphoid pericardiotomy was done under local anesthesia in 77% of 57 patients with various diseases, with general anesthesia required in the others.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Neoplastic pericardial disease: Old and current strategies for diagnosis and management

Lestuzzi¹

2010

WJC

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The prevalence of neoplastic pericardial diseases has changed over time and varies according to diagnostic methods. The diagnostic factor is usually the detection of neoplastic cells within the pericardial fluid or in specimens of pericardium, but the diagnosis may be difficult. Accurate sampling and cytopreparatory techniques, together with ancillary studies, including immunohistochemical tests and neoplastic marker dosage, are essential to obtain a reliable diagnosis. The goals of treatment may be simply to relieve symptoms (cardiac tamponade or dyspnea), to prevent recurrent effusion for a long-term symptomatic benefit, or to treat the local neoplastic disease with the aim of prolonging survival. Immediate relief of symptoms may be obtained with percutaneous drainage or with a surgical approach. For long term prevention of recurrences, various approaches have been proposed: extended drainage, pericardial window (surgical or percutaneous balloon pericardiostomy), sclerosing local therapy, local and/or systemic chemotherapy or radiation therapy (RT) (external or with intrapericardial radionuclides). The outcomes of various therapeutic approaches vary for different tumor types. Lymphoma and leukemias can be successfully treated with systemic chemotherapy; for solid tumors, percutaneous drainage and the use of systemic and/or local sclerosing and antineoplastic therapy seems to offer the best chance of success. The use of "pure" sclerosing agents has been replaced by agents with both sclerosing and antineoplastic activity (bleomycin or thiotepa), which seems to be quite effective in breast cancer, at least when associated with systemic chemotherapy. Local chemotherapy with platinum, mitoxantrone and other agents may lead to good local control of the disease, but the addition of systemic chemotherapy is probably relevant in order to prolong survival. The surgical approach (creation of a pericardial window, even with the mini-invasive method of balloon pericardiostomy) and RT may be useful in recurring effusions or in cases that are refractory to other therapeutic approaches.

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Pericardial window: Mechanisms of efficacy

Cited by 74 publications

References 14 publications

Does posterior pericardial window technique prevent pericardial tamponade after cardiac surgery?

Does posterior pericardial window technique prevent pericardial tamponade after cardiac surgery?

Manejo del derrame pericárdico en el paciente con cáncer

Neoplastic pericardial disease: Old and current strategies for diagnosis and management

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