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Laparoscopic pericardial fenestration A video presentation:

Laparoscopic pericardial fenestration A video presentation Rajiv Padankatti Prakash Agarwal R K Bagdi Neville Solomon

Case history:

Case history 10 yr old girl child Known case of DORV/ VSD/ PS Underwent Glen shunt -1 st surgery 5 months back Redo- Rastelli procedure 2 months back Post op pleural effusion needing prolonged ICD repeated pleurodeisis Hopitalised for almost 45 days


Problem Pericardial effusion not manageable by pericardiocentesis – done twice Inability to approach through the thorax Her chest already bore multiple scars A more permanent solution for the effusion/ chylous fluid in the pericardium was sought The effusion was affecting outcome of cardiac procedure

Pediatric surgeons’ role:

Pediatric surgeons’ role Abdominal route was the only way to drain the pericardial collection Child and parents were upset about the scars on the chest/ ICD sites Was there a solution - minimally invasive? We searched the Internet

Literature :

Literature Iranian Journal of Medical Sciences. Vol. 20, 1995 Laparoscopic Pericardial Fenestration in Malignant Pericardia Effusion Surgical Endoscopy Vol 16, 2002 Laparoscopic transabdominal pericardial window – New standard in the treatment of recurrent pericardial effusion complicated by cardiac tamponade Bratisl Lek Listy Vol 108, 2007 Miniinvasive treatment of pericardial effusions

Technical details:

Technical details Supine position 4 ports as shown Continuous transoesophageal echocardiographic monitoring Pressures of 10-12, flow of 4 Pressures reduced after pericardial window

Laparoscopic pericardial fenestration:

Laparoscopic pericardial fenestration

Post-op period:

Post-op period Child shifted to ICU for monitoring No ascites documented by scan after 48 hours Good resolution of pericardial effusion Pleural effusion – ICD removed after 48 hours HPE of pericardium – Chronic Inflammation Discharged on 4 th postop day

Follow up:

Follow up No ascites No pericardial effusion Good improvement in cardiac function No diaphragmatic hernia At 1 week and 1 month F/U

Why minimal invasive?:

Why minimal invasive?

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