Surgical Options for Management of Pericardial Effusion
Condition: Pericardial Effusion
MeSH terms: Pericardial Effusion
Study type: Interventional

Summary: 
      This is a retrospective descriptive study which will be conducted at Sohag university
      Hospital, Sohag, Egypt at emergency and cardiothoracic department . It includes all patients
      with pericardial effusion who diagnosed as temponading pericardial effusion or threatened
      cardiac temponade , The aim of this work is to clarify the suitability and individualization
      of each surgical procedure (either subxiphoidal drainage, drainage through thoracotomy or
      video-assisted thoracoscopic (VATS) pericardiotomy) in treatment and diagnosis of patients
      presenting with pericardial effusion .
    

Detailed description: 
      The normal pericardial space contains up to 50 ml of fluid that formed of a plasma
      ultrafiltrate and the amount greater than this amount is considered as a pathologic effusion.

      The curvilinear pressure-volume relationship of the pericardial sac leads to the consequences
      of the pericardial effusion specially the rapidly accumulating fluid that causes cardiac
      tamponade.

      There is a lot of diseases and complications that vary in causing pericardial effusion e.g
      idiopathatic pericarditis, malignancy, connective tissue diseases and heamorrhage. The
      management of pericardial effusion depends on whether there is tamponade or not.

      Despite the new diagnostic strategies and the recent data have improved our ability to assess
      the presence and the amount of pericardial effusion, and assess the cause and its
      heamodynamic impact, the optimal management of the pericardial effusion is still
      controversial. While the Echocardiography is the corner stone in the management, multimodal
      imaging strategies specially computed tomography are dependable. The optimal therapy for
      symptomatic pericardial effusions remains controversial. In general, there are surgical based
      approaches and percutaneous-based approaches to pericardial fluid drainage.

      A surgical subxiphoid approach for draining a pericardial effusion was first described in
      1829 and there have been several additional methods proposed for surgical pericardial
      effusion drainage since that time.

      In 1986, Kopecky and colleagues reported the first percutaneous pericardiocentesis series
      with multiple subsequent reports characterizing the relative safety and efficacy of a
      percutaneous approach.

      Initially, pericardial effusion is classified by the volume of effusion. The treatment is
      directed at the primary disease in patients with a small amount of effusion without symptoms.
      In contrast, pericardiocentesis is performed for patients who are vitally unstable and with a
      massive amount of effusion to prevent cardiac tamponade, Surgical drainage of pericardial
      effusion was classically conducted by either open thoracotomy or subxiphoid pericardiectomy.

      Thoracoscopy has established itself as an alternative to open thoracotomy for the management
      of many pericardial, pleural and pulmonary disorders. Thoracoscopic cardiac procedures have
      been performed less frequently. It affords excellent visualization of the pericardial
      surface, thus allowing the safe performance of pericardial resection and formation of a
      pericardial window.

      A pericardial window allows drainage of pericardial fluid into the adjacent space, usually
      the pleural cavity. The subxiphoid approach is erroneously referred to as a "window" because
      no connection is made to the adjacent space during the standard subxiphoid approach.

      The thoracoscopic approach creates a true window but it is done under general anaesthesia
      with single-lung ventilation and through 2 or 3 intercostal ports. However, the role of the
      thoracoscopic approach is limited in patients with hemodynamically significant pericardial
      effusions due to the positioning of the patients in the lateral decubitus which makes
      emergency pericardiocentesis very difficult.

      Recently , video-assisted thoracoscopic (VATS) pericardiotomy has gained popularity as a
      minimally invasive approach. VATS allows for visual evaluation of the pericardium and is used
      when the diagnosis of pericardial effusion has remained undiagnosed despite previous,
      less-invasive tests. It is also used to drain the excess fluid and prevent its
      reaccumulation.

      Choosing the best surgical approach to drain the pericardial effusion is a matter of debate
      and it should be based upon the effectiveness of the approach in avoiding recurrence of the
      pericardial effusion and upon the morbidity and mortality associated with the procedure.
      Moreover, the relative simplicity of the procedure and its cost are other important aspects
      that should be considered when choosing the optimal surgical approach.
    

Intervention name(s): pericardial effusion drainage
Intervention type(s): Procedure
Intervention description(s): tamponading pericardial effusion is a life threatenning condition , pericardiocentesis is performed for patients who are vitally unstable and with a massive amount of effusion to prevent cardiac tamponade, Surgical drainage of pericardial effusion was classically conducted by either open thoracotomy or subxiphoid pericardiectomy. Thoracoscopy has established itself as an alternative to open thoracotomy for the management of many pericardial, pleural and pulmonary disorders
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment