Ch 107 Pericardial surgery Flashcards

Question

What are the surgical options for pericardial effusion? (4)

Answer 1

Pericardiectomy - Subtotal or complete (complete does not improve outcomes) - through a median sternotomy or ICT Thoracoscopic pericardial window - 3x3cm window in large breed dogs (too large risk cardiac herniation) - Transdiaphragmatic (subxiphoid with right 4th and 7th ICS or right and left 7th ICS) or intercostal approach - biopsy masses Thoracoscopic subtotal pericardiectomy - Transdiaphragmatic approach with instrument cannulas in left and right 9th ICS Percutaneous Balloon Pericardiotomy

Answer 2

- can be curative for idiopathic pericardial effusion and possibly palliative for neoplastic - decreases the surface area of pericardium, thus reducing fluid production - increases the surface area for absorption by allowing fluid into the pleural cavity

Answer 3

Neoplastic: - HSA MST 16d - Aortic body tumours, MST 730d with Sx vs 42d - Mesothelioma usually deveolps unremitting pleural effusions 1.5-5m post pericardiectomy. MST 10.5-13.6m Idiopathic - Excellent - Subtotal pericardiectomy 100% surviva at 3yr (Dunning et al) - Another study 12% dies periop, 16% died within 1 yr, 72% long term survival - Pericardial window MST 13.1m, 35% survival at 3yr - MST 22m pericardiocentesis ONLY - outcome is variable - 9 of 14 dogs (one to three treatments), most alive follow-up 3 years late - palliative for HSA pleural effusion - most common complication undergoing pericardiectomy - if lasts > 30 days, more likely to have a poor prognosis

Answer 4

- Chronic inflammation of the pericardium results in extensive fibrous tissue proliferation and pericardial thickening. - Severe lesions can constrict the heart, which compromises cardiac filling and CO - caused by any condition that results in chronic pericarditis. pathophys - noncompliant pericardium abruptly limits ventricular filling and produces near equilibration of all cardiac chambers. As the condition worsens, cardiac output declines - RCHF from activation of the RAAS

Answer 5

Paradoxical, persistent increase in jugular venous pressure during inspiration - Assoc with constrictive pericarditis - Negative intrathoracic pressure during inspiration is not transmitted to the cardial chambers

Answer 6

Cardiac catheterisation - Measurement of pulmonary capillary wedge, atrial and ventricular pressures - Increased and equilibration or near-equilibration of diastolic filling pressures in all chambers

Answer 7

Subtotal pericardiectomy - Relieved clinical signs in 6/10 dogs - Prognosis more guarded if epicardium involved - required decortication - Prognosis poor if develops after treatment of pericardial effusion

Answer 8

Retrospective, ventricular fibrillation as a complication of pericardiectomy in 16 dogs thoracoscopy (12), ICT (3) and MS (1). Electrosurgical devices used in 15 of 16 dogs. VF appeared initiated during electrosurgical use in 8/15 dogs 14 /16 (87%) dogs died from intraoperative VF incidence of VF = 3% In most > fatal complication of pericardiectomy. Three dogs were successfully converted to a sinus rhythm mechanisms for electrosurgical induction of VF - high current during T wave > immediately induces VF - multiple pulses of lower current (over 1-5 s) to epicardial cells - very low current over 90-300 s > increase in heart rate.

Answer 9

Systematic review > pericardial effusions in dogs. Most case studies (68.2%) or retrospective case series (25.2%) = low level of evidence. variability of the outcomes > not sufficient evidence to recommend one treatment option over another. subtotal pericardiectomy > longer survival time and DFI than thoracoscopic window > quality of evidence low idiopathic pericarditis/pericardial effusion → long-term survival with pericardectomy - difference between subtotal and thoracoscopic window uncertain - complete examination at time of surgery of heart and pericardium > to try ensure rule out neoplasia as affects survival outcomes neoplastic pericardial effusion → no prolongation of MST or DFI after sx vs conservative (hemangiosarcoma or mesothelioma) - when cardiac mass was present – pericardiectomy resulted in less recurrence of CS - no difference between subtotal and thoracoscopic window - Medications Yunnan Baiyao, aminocaproic acid, and chemotherapies > no clear benefit

Answer 10

Retrospective case series. Animals: Sixteen client-owned dogs. Thoracoscopic subtotal pericardiectomy can be readily performed with only 2 instrument ports, both on the same side of the dog, and without 1-lung ventilation. no surgical complications. The median duration of postoperative follow-up was 191.5 days (range, 5–1345). The median survival time (MST) after surgery was 365 days (range, 5–1345); MST of dogs with a histopathological diagnosis of neoplasia (n = 4) was 76 days, whereas dogs with no evidence of neoplasia had an MST of 367 days (n = 12, P = .14). Recurrent pleural effusion was the ultimate cause of death or reason for euthanasia in 8 of 16 dogs.

Answer 11

Multi-institutional retrospective study (2011-2017). Animals: Eighteen dogs Nine dogs had pericardioscopic abnormalities consistent with masses, nodules, or adhesions. Median survival time (MST) for the 9 dogs with abnormalities identified by pericardioscopy was 66 days, whereas MST for the 9 dogs with unremarkable pericardioscopic examination results was not reached (P = .0067). Median survival time for dogs based on histopathologic diagnosis alone was not different between dogs with a diagnosis of neoplasia and dogs with a diagnosis of pericarditis Thoracoscopic pericardectomy/pericardioscopy and targeted biopsy of the pericardium and pleura are recommended in dogs with echocardio graphic idiopathic pericardial effusion

Answer 12

describe a novel technique for thoracoscopic pericardectomy using a pericardial window with vertical pericardial fillets (PW1F). (2) To compare epicardial exposure between a standard pericardial window (PW) and PW1F.

Ch 107 Pericardial surgery Flashcards

(36 cards)