Severe Case of Idiopathic Chronic Pericarditis Treated by Video Transthoracic Pericardial Fenestration

Figures

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  Figure 1. Chest X-ray and CT scan before surgery. A) chest X-ray before surgery. Significant cardiomegaly is shown with red arrows. B) sagittal view of contrast body CT scan. Pericardial effusion is remarkable (red arrow). C: axial view of contrast chest CT scan. Significant cardiomegaly and pericardial effusion are shown (red arrow).

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  Figure 2. The Left atrial appendage is exposed. After incising the pericardium, the left atrial appendage was exposed.

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  Figure 3. The Left atrial appendage was clipped. The left atrial appendage was closed using a device.

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  Figure 4. Resection of the pericardium. Anterior pericardium, ventral to the phrenic nerve, was resected.

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  Figure 5. Pericardial fenestration was performed. A wide pericardial window was created.

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  Figure 6. Histopathological image of pericardium, stained with hematoxylin and eosin. Mesothelial cells are observed on the surface of the pericardium, and the wall is supported by collagen fibers. Focal clusters of lymphocytes and plasma cells are shown. These findings are consistent with a mildly inflamed pericardium.

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  Figure 7. Chest X-ray and contrast CT scan after surgery. A) chest X-ray after surgery. The LAA clipping device is shown (red arrow). B) Sagittal view of contrast chest CT scan after surgery. Pericardial effusion remarkably decreased (red arrow). C) axial view of contrast CT scan after surgery. A small amount of pleural congestion is observed (red arrow).