Video-assisted thoracoscopic pericardial window for massive pericardial effusion: South Egypt experience

Symptomatic pericardial effusion (PE) is a common cardiothoracic presentation. It may reflect a wide variety of causes, ranging from infection to malignancy. The optimal management of pericardial effusion is still controversial. The two main interventional procedures agreed in the last decade as the two reasonable options for PE treatment are: surgical (transthoracic or subxiphoid) and video-assisted thoracoscopy (VATS) pericardial window. In this study we report our experience in VATS pericardial window in the management of massive pericardial effusion. This prospective study was conducted between May 2013 to December 2015. Patients with massive pericardial effusion with or without tamponade, diagnosed by transthoracic echocardiography, and sometimes with chest computed tomography (CT) scan were included. Fifty-three patients with massive PE were included in the study, 33 males and 20 females, aged from 20 to 55 years. The causes of PE were malignancy 15 cases; uremia 5 cases; tuberculosis 8 cases; chronic non specific inflammation 13 cases and idiopathic in 12 cases. The main clinical presentation was dyspnea in the majority of cases (57%), followed by fever (15%), chest pain (8%), and (7.5%) were asymptomatic at time of presentation. 7 cases (13%) were unstable with signs of tamponade. The amount of fluid drained averaged 450 ± 95 ml (from 350 to 600 ml). The mean operative time was 120.45 ± 34.67 min. Lung injury, air leak, transient ventricular arrhythmias, and atelectasis were the main complications. The mean hospital stay was 9 days, and the mean chest tube duration was 4.3 days. There were no perioperative deaths. The Thirty-day mortality was 11%. Recurrence occurred in 3 patients (5.6%). VATS pericardial window is an effective, safe and minimally-invasive technique for PE drainage and taking pericardial, pleural and lung biopsies.