The Role of Videopericardioscopy in Evaluating Indeterminate Pericardial Effusions
DOI:
https://doi.org/10.1532/HSF98.20071190Abstract
Background. The pericardial biopsy has opened a new perspective for the etiologic diagnosis of pericardial effusions, because adequate pericardial visualization via the use of a video camera can provide more accurate results. We assessed the usefulness of videopericardioscopy for the diagnosis and treatment of pericardial effusion of indeterminate origin.
Methods. We conducted a retrospective study of clinical data from patients who underwent videopericardioscopy examination for pericardial effusion without an established diagnosis. The video-assisted pericardioscopy procedure was performed through a small incision in the xiphoid area.
Results. From January 1998 to January 2007, 101 consecutive patients underwent videopericardioscopy evaluation for pericardial effusion. Ten patients were excluded because of lack of data. Fifty men and 41 women were included (mean age, 50 years; range, 14-76 years). All of the patients had moderate or significant pericardial effusion as demonstrated by echocardiography or computed tomography. The following diagnoses for the pericardial effusions were established: nonspecific inflammation, 50 cases (54.94%); neoplastic disorders, 22 cases (24.17%); tuberculous, 11 cases (12.08%); bacterial inflammatory process, 3 cases (3.29%); chylopericardial, 2 cases (2.19%); fungal infection, 2 cases (2.19%); and viral infection, 1 case (1.09%). Pericardioscopy evaluation provided the definitive diagnosis via the pericardial biopsy in 36.26% of the cases and via the results of fluid analyses in 13.18% of the cases; the use of both methods established the definitive diagnosis in 45.05% of the cases in this group of patients. The overall morbidity rate was 4.3%, and the most common complication was arrhythmia due to intraoperative manipulation, which ceased with the removal of the instruments from the pericardial cavity. We had 1 death, by cardiac tamponade, in the perioperative period.
Conclusion. Videopericardioscopy is a safe and efficient method for obtaining a better diagnosis of and satisfactory therapeutic results for pericardial effusions of indeterminate cause, and such results are obtained via an improved exploration of the pericardial cavity.
References
Fernandes F, Ianni BM, Arteaga E, Benvenutti L, Mady C. 1998. Value of pericardial biopsy in the etiologic diagnosis of pericarditis [in Portuguese]. Arq Bras Cardiol 70:393-5.nKaranaeff P. 1840. Paracentese des Brustkastens und des Pericardiums. Med Z 9:251-3.nMaisch B, Seferovic PM, Ristic AD, et al. 2004. Guidelines on the diagnosis and management of pericardial diseases executive summary: the Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology. Eur Heart J 25:587-610.nNugue O, Millaire A, Porte H, et al. 1996. Pericardioscopy in the etiologic diagnosis of pericardial effusion in 141 consecutive patients. Circulation 94:1635-41.nPêgo-Fernandes PM, Fernandes F, Ianni BM, et al. 2001. Video-assisted pericardioscopy: how to improve diagnostic efficacy in pericardial effusions [in Portuguese]. Arq Bras Cardiol 77:399-406.nPorte HL, Janecki-Delebecq TJ, Finzi L, Métois DG, Millaire A, Wurtz AJ. 1999. Pericardioscopy for primary management of pericardial effusion in cancer patients. Eur J Cardiothorac Surg 16:287-91.nSantos GH, Frater RW. 1977. The subxiphoid approach in the treatment of pericardial effusion. Ann Thorac Surg 23:467-70.nSeferovic PM, Ristic AD, Maksimovic R, Tatic V, Ostojic M, Kanjuh V. 2003. Diagnostic value of pericardial biopsy: improvement with extensive sampling enabled by pericardioscopy. Circulation 107:978-83.nShumacker HB Jr. 1989. When did cardiac surgery begin? J Cardiovasc Surg (Torino) 30:246-9.nSuen ALW, Sing HL, Yin CN, Tong CM, Hung TH, Fong KM. 1999. Techniques and outcomes of two modes of pericardial drainage. Asian Cardiovasc Thorac Ann 7:292-6.n