175P - A novel technique for the management of reccurent malignant pericardial effusions

Date 17 April 2015
Event ELCC 2015
Session Poster lunch
Topics Supportive Care
Lung and other Thoracic Tumours
Presenter Nikolaos Panagiotopoulos
Citation Annals of Oncology (2015) 26 (suppl_1): 51-54. 10.1093/annonc/mdv053
Authors N. Panagiotopoulos, D. Patrini, B. Adams, D. Lawrence
  • Cardiothoracic Surgery, UCL - University College London, W1G8PH - London/UK

Abstract

Aim/Background

Pericardial effusions can pose significant morbidity to patients. Their etiology may be benign often from idiopathic causes or uraemia. Malignant origins are commonly from lung, breast, and haematological malignancy. Various strategies are available to treat pericardial effusions, from medications such as steroids, interventional methods such as pericardiocentesis, and surgical options pericardiotomy, and pericardial window. A pericardial-peritoneal window allows continuous drainage into the peritoneal cavity hence preventing accumulation.

Methods

The patient undergoes general anaesthesia and is intubated with a single lumen tube. A 5-8cm incision is made in the midline below the xiphoid process. The linea alba is exposed, and divided. The parietal peritoneal surface is grasped with 2 Alice clamps tenting the peritoneum a small cut is made to enter the peritoneal cavity.The peritoneal surface of the diaphragm is exposed. A small window is created in the diaphragm to enter the mediastinum. A small breach into the diaphragmatic surface of the pericardium and fluid is collected for labaoratory investigations. A small window 4cm by 4cm is created in the pericardium. This can be used for tissue investigation. A GIA endostapler is used to staple along the edges of the pericardium and diagragmatic window. The linea alba, subcutenous tissue and skin are closed in a routine manner in layers.

Results

During the procedure the pericardium is under direct visualization hence the risks of percutaneous approaches are precluded such as ventricular arrhythmia, laceration of coronary artery or puncture of the right ventricle.We believe that the subxiphoid approach is associated with reduced morbidity and mortality compared to the anterior thoracotomy opening. A staple line along the edges of the window the shunt remains patent and prevents reaccumulation in the pericardial cavity, hence improved quality of life, and palliation from symptoms.

Conclusions

The pericardial-peritoneal window represents a desirable and safe option for the management of recurrent malignant pericardial effusions.

Disclosure

All authors have declared no conflicts of interest.