Perikardiektomia torakoskopowa. Wskazania i techniki u małych zwierząt. Część II/Thoracoscopic pericardectomy. Indications and techniques in small animals. Part II

Sub-total pericardectomy versus pericardial window

Both subphrenic pericardectomy and creation of a pericardial window have been described using the paraxiphoid and subxiphoid approaches. In the former, the pericardium is resected up to 1 cm ventral to the phrenic nerve (28, 33), while in the latter, a smaller amount of pericardium (4-5 cm in diameter for an average-size dog) is removed (38). Theoretically, subphrenic pericardectomy is optimal in cases of constrictive pericarditis and pericardial infection or neoplasia, while the pericardial window can be used in cases of neoplastic effusions, hemorrhage from neoplastic masses, inflammatory disease, and idiopathic effusions.

In one pericardioscopic study of cadavers (39), subphrenic pericardectomy allowed for better viewing of most intrapericardial structures than did the creation of an apical pericardial window. Greater than 50% visibility of the right atrium, right auricle, and left auricle was possible. Subphrenic pericardectomy improved observation of the aortic root and pulmonary artery, which is important in cases of mesothelioma or chemodectoma.

Although subphrenic pericardectomy may not be necessary in all dogs with pericardial effusion, it may improve diagnostic accuracy during pericardioscopy.

The pericardial window procedure was evaluated in a more recent study (37). This procedure was associated with an acceptable complication rate (approximately 25%), low mortality rate (7%), rapid operative duration (<1 hour), and relatively short hospitalization time (1 day). In that study, of seven dogs with idiopathic pulmonary effusion, three died of uninvestigated lethargy and two were euthanized 638 and 1165 days after surgery, respectively, because of dyspnea secondary to persistent pleural effusion.

These findings and those obtained by Case et al. (32) again raise the question of the value of a simple pericardial window with respect to the long-term prognosis. Our recommendation is t...

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