Minimally Invasive Surgery for Pericardial Effusion and Tamponade - PowerPoint PPT Presentation

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Minimally Invasive Surgery for Pericardial Effusion and Tamponade

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Minimally Invasive Surgery for Pericardial Effusion and Tamponade. Partial ... Starling forces. DDx by Light criteria. Sp. Gr., protein, glucose, LDH, cultures ... – PowerPoint PPT presentation

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Title: Minimally Invasive Surgery for Pericardial Effusion and Tamponade


1
Minimally Invasive Surgery for Pericardial
Effusion and Tamponade
  • Partial pericardiectomy
  • Hemostasis
  • Chest tube drainage

Pericardial window
2
Thoracoscopic Pericardiectomy for Malignant
EffusionSurvival in Months
3
Thoracoscopic PericardiectomySurvival in Months
N22
4
Malignant Pericardial EffusionComparative
Survival
5
Malignant Pericardial Effusion Comparative
Survival Breast CA
6
Malignant Pericardial Effusion Comparative
Survival Lung CA (NSC)
7
Conclusion
  • Thoracoscopic pericardiectomy is a
  • Simple
  • Safe
  • Effective
  • technique for the management of malignant
    pericardial effusion and tamponade

8
Pleural Effusion
Inverts the diaphragm, so thoracic cavity gets
smaller with inspiration L2 dyspnea
  • Very common clinical problem.
  • Starling forces
  • DDx by Light criteria
  • Sp. Gr., protein, glucose, LDH, cultures
  • Pleural Bx gt thoracoscopy
  • DOE caused by paradoxical diaphragm
  • Rx depends upon Dx

Always do a pleurocentesis
9
Malignant Pleural Effusion
Almost never a transudate
Any CA can cause this, but most common w/
  • Very common clinical problem in tumors that
    involve thoracic nodes
  • LunggtBreastgtLymphoma.
  • Short survival
  • Adverse QOL
  • Effective palliative Rx is currently by
    pleurodesis.

Stick parietal w/ visceral pleura
10
Thoracoscopy
Tumor nodule
  • Minimally invasive technology
  • Better visualization of intrathoracic structures
  • Limited palpation
  • Technical Limitations
  • Technology is in evolution
  • Diagnostic
  • Therapeutic
  • benign nodules and mediastinal tumors
  • metastases
  • lung CA? Nope

11
Pleurodesis
  • Instill a substance into the pleura that causes
    inflammation and symphysis of the visceral and
    parietal pleura.
  • No residual space is left for recurrence of
    effusion.
  • Chest tube alone lt40
  • Tetra-Doxycycline
  • lt 60
  • Bleomycin better than Doxy but .
  • Talc lt70-90
  • slurry
  • powder via thoracoscope

Cheap like mud
12
PleurX Catheter
For pleurodesis
Other Tx can be given thru this catheter
  • New technique
  • Outpatient placement of silastic cuffed catheter.
  • Outpatient drainage of recurrent pleural effusion
    for palliation.

catheter
13
Chylothorax
  • Leakage of chyle from a defect in the thoracic
    duct.
  • High fat, protein loss.
  • Death by starvation.
  • Etiology
  • congenital
  • trauma
  • tumor
  • Rx thoracic duct ligation

Usu. milky white liquid
Tx
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