VATS Pericardiectomy for Tuberculosis Fibrinous Pericarditis

The authors present the case of a 68-year-old patient with fibrinous pericarditis with clinical and echocardiographic symptoms of tamponade.

Despite not having prior lung involvement, the initial suspicion of the disease was a tuberculosis of extrapulmonary location, given that the patient was a resident in a geographical area with a high prevalence of this disease.

The authors proceeded with left triportal technique, nonselective orotracheal intubation, and CO2 insufflation at low pressure in the pleural cavity: 6 mm hg and 6 lts under flow. The authors used 30-degree optics.

With the Harmonic device (Johnson & Johnson) and with reference of the left frenic nerve, the authors initially performed a pericardial window for gradual decompression and sampling for bacteriological and hystopathological study.

Then the authors resected the entire anterior pericardium with the right and left phrenic nerves as references. After using blunt maneuvers and endoscopic instruments, they proceeded to debride and remove all the fibrinous material in the residual pericardial sac and in the epicardial surface. Finally they cleaned with physiological serum warm and placed a multifenestrate drainage fr 28 directed towards the bottom of the costodiaphragmatic sac. Once the procedure was finished, it was extubated in the operating room.

Post operative without incidents. The histopathological study of Pericardium confirmed the diagnosis of tuberculosis.

Complete scheme of tuberculosis treatment. One year of follow-up without evidence of recurrence or contamination of the ports sites. The surgical technique is reproducible and effective.

References

  1. Mizukami Y, Ueda N, Adachi H, Arikura J, Kondo K. Long-term outcomes after video-assisted thoracoscopic pericardiectomy for pericardial effusion. Ann Thorac Cardiovasc Surg. 2017 Dec 20;23(6):304-308.
  2. Yoshida M, Sakiyama S, Kondo K, Tangoku A. Thoracoscopic pericardial fenestration for effective long-term management of non-tuberculous mycobacterium pericarditis. Gen Thorac Cardiovasc Surg. 2015 Jan;63(1):49-51.
  3. Fernández JA, Robles R, Acosta F, Sansano T, Parrilla P. Cardiovascular changes during drainage of pericardial effusion by thoracoscopy. Br J Anaesth. 2004 Jan;92(1):89-92.

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