Prevention of cardiac herniation and left artery descending obstruction in cases of extensive surgical pericardial window procedure

The thoracotomy approach was shown to be an effective surgical access in terms of preventing effusion recurrence and the need for repeat surgery (1). However, cardiac herniation remains a potential complication after extensive pericardial excision (2,3). A 54-year old female with a symptomatic chronic pericardial effusion significantly increasing in size over months (Figure 1) with the background of anti-cyclic citrullinated peptide (anti-CCP) antibody positive rheumatoid arthritis underwent surgical pericardial window procedure through left anterior mini-thoracotomy. A large area of anterolateral pericardium was excised creating a generous (13 cm × 6 cm) pericardial window with the view to achieving appropriate long-term drainage. In order to prevent potential heart herniation through the pericardial window an 8-mm wide pericardial stripe was attached to both edges of the window using two single 5-0 sutures (Figure 2). Not only can this simple surgical technique prevent cardiac herniation but also avoids potential obstruction of the left artery descending that can occur when a simple suture connecting both pericardial edges is used instead. Postoperatively the patient did not show any complications and has been doing well for more than 1 year of follow-up.

Figure 1 Chronic pericardial effusion with the background of anti-cyclic citrullinated peptide (anti-CCP) antibody positive rheumatoid arthritis on the MRI-scan.

Figure 2 An 8-mm wide pericardial stripe is attached to both edges of the window using two single 5-0 sutures preventing cardiac herniation on one side and obstruction of the left artery descending on the other side.

Acknowledgements

None.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

References

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