Minimally Invasive Surgery for Pericardial Effusion and Tamponade

Minimally Invasive Surgery for Pericardial Effusion and Tamponade

• Partial pericardiectomy

• Hemostasis• Chest tube drainage

Pericardial window

Thoracoscopic Pericardiectomy for Malignant Effusion:Survival in Months

Thoracoscopic Pericardiectomy for Malignant Effusion:Survival in Months

0 1 2 3 4 5 6 7 8 9 10 11 12

S u rv i v a l i n mo . N=2 2

0%10%20%30%40%50%60%70%80%90%

100%

``

Thoracoscopic PericardiectomySurvival in Months N=22

Thoracoscopic PericardiectomySurvival in Months N=22

0%

50%

100%

months 2 4 6 8 10 12

lu n g N=1 0

b re a st N=9

h e ma to lo g ic N=3

lung N=10

breast N=9

hematologicN=3

Malignant Pericardial Effusion:Comparative Survival

Malignant Pericardial Effusion:Comparative Survival

0%

20%

40%

60%

80%

100%

120%

Alb subx N=82Mem sclerosis N=37COH tscop N=22

Malignant Pericardial Effusion: Comparative Survival Breast CA Malignant Pericardial Effusion:

Comparative Survival Breast CA

1 2 3 4 5 6 7 8 9 10 11 12

C OH tsc o p N= 9

A lb su b x N =2 3

0%

20%

40%

60%

80%

100%

COH tscop N=9Alb subx N=23

Malignant Pericardial Effusion: Comparative Survival Lung CA (NSC)

Malignant Pericardial Effusion: Comparative Survival Lung CA (NSC)

1 2 3 4 5 6 7 8 9 10 11 12

A lb su b x N =3 0

C OH tsc o p N= 1 0

0%

20%

40%

60%

80%

100%

Alb subx N=30

COH tscop N=10

Conclusion:Conclusion:

• Thoracoscopic pericardiectomy is a

• Simple

• Safe

• Effective

• technique for the management of malignant pericardial effusion and tamponade

Pleural Effusion• Very common clinical

problem.• Starling forces• DDx by Light criteria

– Sp. Gr., protein, glucose, LDH, cultures

• Pleural Bx > thoracoscopy• DOE caused by

paradoxical diaphragm• Rx depends upon Dx

Inverts the diaphragm, so thoracic cavity gets smaller with inspiration L2 dyspnea

Always do a pleurocentesis

Malignant Pleural Effusion

• Very common clinical problem in tumors that involve thoracic nodes

• Lung>Breast>Lymphoma.

• Short survival

• Adverse QOL

• Effective palliative Rx is currently by pleurodesis.

Almost never a transudate

Any CA can cause this, but most common w/

Stick parietal w/ visceral pleura

Thoracoscopy:

• Minimally invasive technology

• Better visualization of intrathoracic structures

• Limited palpation• Technical Limitations

• Technology is in evolution

• Diagnostic• Therapeutic

– benign nodules and mediastinal tumors

– metastases

– lung CA? Nope

Tumor nodule

Pleurodesis

• Instill a substance into the pleura that causes inflammation and symphysis of the visceral and parietal pleura.

• No residual space is left for recurrence of effusion.

• Chest tube alone <40%• Tetra-Doxycycline • < 60%• Bleomycin better than

Doxy but $$$.• Talc <70-90%

– slurry– powder via thoracoscope Cheap; like mud

PleurX Catheter:

• New technique• Outpatient placement

of silastic cuffed catheter.

• Outpatient drainage of recurrent pleural effusion for palliation.

For pleurodesis

catheter

Other Tx can be given thru this catheter

Chylothorax:• Leakage of chyle from a

defect in the thoracic duct.

• High fat, protein loss.• Death by starvation.• Etiology

– congenital

– trauma

– tumor

• Rx thoracic duct ligation

Usu. milky white liquid

Tx