Subxiphoid pericardial window

Fontenelle, Larry J.; Cuello, Leo; Dooley, Byron N.

doi:10.1016/s0022-5223(19)42111-9

Cited by 34 publications

(5 citation statements)

References 6 publications

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“…Napoleon's surgeon, Dominique Larrey, rst used the subxiphoidal approach to drain pericardial effusion in 1829 (13). This procedure was revived in the 1970s and 1980s as a fast, simple, safe and effective drainage procedure (14). The subxiphoid procedure has been successfully performed in patients with tamponade in whom a pericardiopleural window could not be created because bilateral pleurodesis was previously performed (15).…”

Section: Discussionmentioning

confidence: 99%

Pericardioperitoneal window creation for recurrent pericardial tamponade: A case report and literature review

EKİM,

EKİM

2024

Preprint

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Background: As a result of the increased life expectancy of cancer patients due to developing effective treatments applied, the incidence of secondary patterns such as malignant pericardial effusion has increased. Therefore, pericardial effusions leading to cardiac tamponade have been becoming an increasingly common emergency in medical practice. Although positive results are obtained with echocardiography-guided pericardiocentesis or percutaneous catheter drainage in pericardial effusions causing tamponade, the effusion may recur in some malignant cases. In the management of such patients, it is desirable to provide permanent drainage by opening a pericardial window instead of performing frequent pericardiocentesis. Case Presentation: A 62-year-old male patient with tamponade was admitted to our hospital. The clinical picture was corrected by pericardiocentesis accompanied by echocardiography. However, due to rapid fluid accumulation that required pericardiocentesis every other day, he was referred to the cardiovascular surgery department for surgical drainage. The patient clinically improved after the subxiphoid pericardial window was created. However, when symptoms of tamponade developed again 24 hours after the chest tube was removed, a pericardioperitoneal window was opened with a subxiphoidal approach. There were no recurrences of effusion for three months until the patient died of malignancy. Conclusion: In patients who have undergone pleurodesis or who are not suitable for general anesthesia due to their hemodynamic conditions, the best surgical procedure to prevent recurrent effusions causing tamponade is to create a pericardioperitoneal window under local anesthesia.

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Section: Discussionmentioning

confidence: 99%

Pericardioperitoneal window creation for recurrent pericardial tamponade: A case report and literature review

EKİM,

EKİM

2024

Preprint

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“…Two major surgical procedures are used to release the mediastinum and pericardium: the Chamberlain procedure ( 5 ); and the “pericardial window technique” ( 4 ). The Chamberlain procedure is a method to biopsy the anterior mediastinum via anterior mediastinotomy.…”

Section: Discussionmentioning

confidence: 99%

“…I d i o p a t h i c p n e u m o m e d i a s t i n u m c a n o f t e n b e managed conservatively, but can also progress to tension pneumomediastinum, which is a life-threatening condition with hypotension that necessitates drainage. Several methods to release the mediastinum have been advocated (4,5), but no consensus has been established. We advocate a new method to drain pneumomediastinum from a neck incision, which we successfully applied to drain pneumomediastinum in a mechanically ventilated patient with COVID-19.…”

Section: Introductionmentioning

confidence: 99%

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An approach from the neck to drain expanding pneumomediastinum: a case report

Oka¹,

Kuriyama²

2023

Ann Transl Med

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Background: Several methods for draining pneumomediastinum have been advocated, but no consensus has been established. We propose a novel method for draining air from pneumomediastinum.Case Description: We used an approach from the neck to drain pneumomediastinum that had started to compress the heart in a 33-year-old man with coronavirus disease 2019 (COVID-19) on mechanical ventilation. Computed tomography showed extension of pneumomediastinum to the lateral and dorsal aspects of the right sternocleidomastoid muscle, presenting as subcutaneous emphysema at the neck. We made a 4-cm incision lateral to the right sternocleidomastoid muscle. After incising the platysma muscle, the dorsal side of the sternocleidomastoid muscle was easily stripped off due to the presence of air, allowing placement of a 14-Fr Nelaton catheter. Subcutaneous emphysema as well as pneumopericardium on X-rays improved and disappeared by 3 days after starting drainage. Positive end-expiratory pressure (PEEP) was titrated in a stepwise manner from 6 to 10 cmH 2 O, with no re-appearance of subcutaneous emphysema. The Nelaton catheter at the neck was removed and the skin was sutured using 3-0 Nylon monofilament. Conclusions:We propose this approach from the neck to release air and prevent deterioration of pneumomediastinum communicating with subcutaneous emphysema at the neck.

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“…The existing surgical methods for the management of pericardial fluid are well-established but are not without limitations in providing symptomatic relief of malignant pericardial effusion. Pericardiocentesis and the Larrey-Fontenelle approaches [ 5 , 6 ] using a subxyphoideal fenestration have a recurrence rate ranging between 43 and 69% after pericardiocentesis [ 3 , 7 ] and 9 and 16% after pericardial drainage [ 8 - 11 ]. The video-assisted thoracoscopic surgical (VATS) pericardio-pleural fenestration is highly efficient but requires anaesthesia with contralateral single-lung ventilation which is compromising in patients with an already reduced cardio-pulmonary reserve [ 8 , 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Mediastinoscope-controlled parasternal fenestration of the pericardium: definitive surgical palliation of malignant pericardial effusion

Tóth¹,

Szücs²,

Molnár

2012

J Cardiothorac Surg

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Background The tumorous infiltration or carcinosis of the pericardium could cause pericardial effusion in up to one-third of cases of malignancy, thus potentially interfere with the otherwise desirable oncological treatment. The existing surgical methods for the management of pericardial fluid are well-established but are not without limitations in the symptomatic relief of malignant pericardial effusion (MPE). The recurrence rate ranges between 43 and 69% after pericardiocentesis and 9 to 16% after pericardial drainage. The desire to overcome relative limitations of the existing methods led us to explore an alternative approach. Methods The standard armamentarium of the Carlens collar mediastinoscopy procedure was utilized in a Chamberlain parasternal approach of the pericardial sac. The laterality of approach was decided based upon the pleural involvement, as tumor-free pericardiopleural reflection is required. A pericardio-pleural window at least 3 cm in diameter was created. From January 2000 to December 2009, 22 cases were operated on with mediastinoscope-controlled parasternal fenestration (MCPF). Considering the type of the primary tumor, there were 11 lung cancer, 6 breast cancers, 2 haematologic malignancies and in 3 patients the origin of malignancy could not be verified. Results There were no operative deaths. We lost one patient (4.5%) in the postoperative hospital period. All of the surviving patients had a minimum of 2 months of symptom-free survival. We detected transient recurrence of MPE in one patient (4.5%) 14 days after the MCPF, which disappeared spontaneously after 24 hours. Conclusion The MCPF offers a real alternative in certain cases of pericardial effusion. We recommend this method especially for the definitive surgical palliation of MPE.

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Subxiphoid pericardial window

Cited by 34 publications

References 6 publications

Pericardioperitoneal window creation for recurrent pericardial tamponade: A case report and literature review

Pericardioperitoneal window creation for recurrent pericardial tamponade: A case report and literature review

An approach from the neck to drain expanding pneumomediastinum: a case report

Mediastinoscope-controlled parasternal fenestration of the pericardium: definitive surgical palliation of malignant pericardial effusion

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