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International Society For Minimally Invasive Cardiothoracic Surgery

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Thoracoscopic Pericardial Effusion Management In Obese Patients
Francina Bolanos Morales, luis Fernando Arana Bolaņos, Julio de Jesus Herrera Zamora, Jesus Saucedo Castillo, jorge Manuel Catrip Torres, Patricio Javier Santillan Doherty.
instituto Nacional de Enfermedades Respiratorias INER, Mexico, Mexico.

Background
Pericardial window thoracoscopic is the main treatment nowadays for pericardial effusion. In obese, hemodynamically stable patients the main approach are minimal invasion techniques.

Objectives
Standardization of a thoracoscopic handling with a pericardial window of dimensions 4x4cm in obese and hemodynamic stabile patients with pericardial effusion.

Method
Prospective cohort study, descriptive, observational in a year (January-December 2016) with a population of 17 patients with pericardial effusion presented to the surgical department of our institution. Variables taken in consideration: Body mass index (BMI), gender, age, post operatory stay, corporal and pathology and Microbiological culture results.

Results
In a period of 12 months, 17 thoracoscopic pericardial windows of 4x4cm were done. In post operatory every subject had alterations in the electrocardiography and cardiomegaly grade III/IV visible in thorax radiography. From the 17 subjects, 10 were female and 7 male, average age was 44 +/- 20 years. 29.4% of the patients were overweight (BMI 24-29.9), 23.5% had Obesity I (BMI 30-34.5), 29.4% Obesity II (35-39.9) and 17.7% Obesity III (BMI > 40). The pre operatory diagnosis of pericardial effusion was given in 70.6% of the cases. Every patient was handled under general anesthesia with selective intubation, 91.6% from right side with only one conversion. The average volume evacuated was 481cc (50-1600cc). 70.58% of the cases were diagnosed with chronic pericarditis. Catheters were removed 7.2 +/- days post-surgery, with an output less than 150ml in 24 hours. Only one patient had post-surgery complications.

Conclusion
In patients with hemodynamic instability, pericardiocentesis must be done as soon as possible. In patients with hemodynamic stability, thoracoscopic pericardial window is a feasible, safe and reproductible procedure with the benefits of minimal invasion surgery. Diminish post-surgical complications.


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