Thoracoscopic partial pericardectomy in the dog - DVM
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Thoracoscopic partial pericardectomy in the dog


Photo 3: Each cut in the pericardium is visualized. The scissors are attached to an electrocautery. The epicardial surface is visible. The pericardium can be lifted away from the heart.
Additional ports are placed under direct observation at about the seventh and third left intercostal spaces. Endoscopic graspers are used to pick up pericardium. When a good grasp of the pericardium has been achieved, the pericardium is lifted away from the heart and endoscopic scissors connected to the cautery unit are used to make the first cut in the pericardium (Photo 2). Effusion will spill out at this time. Suction can be used to clear the field if needed. The graspers and cutters are used via the two instrument ports, switching position of the instruments as needed to remove a portion at least 3-cm square from the ventral pericardium. Every cut is visualized to ensure that the lungs and phrenic nerve are not in danger of trauma. The camera can be moved to one of the intercostals ports and the paraxiphoid port used for an instrument. This is occasionally helpful to complete the procedure. Bleeding is usually adequately controlled with the use of cautery through the scissors as each cut is made (Photo 3). Mediastinal vessels can be a source of hemorrhage. Endoscopic clips can be used if needed to aid in control of hemorrhage. Conversion to an open procedure is rarely needed for bleeding that cannot be controlled. The piece of pericardium is removed via the port with the grasper. The port can be withdrawn and the incision enlarged slightly if needed for retrieval. The pericardium is submitted for histopathology, particularly in the absence of a heart base or right atrial mass. A red rubber catheter is placed via the paraxiphoid port and kept in place when the ports are removed to allow evacuation of any fluid and air. The port incisions are closed routinely. The chest is evacuated again at the end of the procedure, then the red rubber catheter is removed.

Postoperative management includes routine monitoring and pain management. Most cases are able to go home the next day. Some pleural fluid is expected after surgery since the underlying source of effusion has not been removed, but the amount of fluid in the pleural space is unlikely to cause clinical signs.

Prognosis

The prognosis depends upon the etiology of the pericardial effusion. The prognosis for hemangiosarcoma is poor. Median survival time with surgical removal of the hemangiosarcoma and chemotherapy has been reported as 175 days, versus 42 days with surgery alone. Aortic body tumors have a relatively good prognosis following pericardectomy. Growth is often slow with only a 10-percent to 20-percent metastatic rate. Evidence of metastatic disease does not significantly alter survival time. Aortic body tumors are reported to have a median survival of 730 days post-pericardectomy versus 42 days without.

The prognosis for IPE is good to excellent. The prognosis for mesothelioma is generally poor. It can be difficult to differentiate IPE from mesothelioma even with histopathology because there can be exuberant mesothelial proliferation present in cases of IPE. Mesothelioma can be seen in small-breed dogs, whereas most IPE is seen in large breeds. Survival times of more than 120 days post-pericardectomy is associated with a higher probability of IPE than mesothelioma.

Constrictive pericardial disease is a rare condition in which pericardial fibrosis results in impaired diastolic function. The clinical signs are of systemic congestion and low cardiac output, and the treatment involves thoracotomy for pericardectomy and potentially epicardial stripping.

Carl Sammarco, BVSc, MRCVS, Dipl. ACVIM (cardiology) joined Red Bank Veterinary Hospital, Tinton Falls, N.J. in 2001. He previously served as a lecturer/assistant clinical professor at the University of Pennsylvania, where he completed a residency in cardiology in 1994 .

Jill Sammarco, BVSc, MRCVS, Diplomate ACVS joined Red Bank Veterinary Hospital in 2003. She completed a residency in surgery at the University of Pennsylvania in 1995 and is a veterinary graduate of the University of Liverpool in England.


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Source: DVM360 MAGAZINE,
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