MASSIVE PLEURAL ADHESIONS DURING THORACOSCOPIC AF ABLATION.
Egor Malyshenko, Vadim Popov, Maxim Novikov, Amiran Revishvili.
A.V. Vishnevskiy National research center of surgery, Moscow, Russian Federation.
BACKGROUND:Pleural adhesions appear to be a contraindication to thoracoscopic AF ablation.
METHODS:A case of thoracoscopic surgical ablation of a long-standing persistent atrial fibrillation in patient with a post-inflammatory adhesive process in the left and right pleural cavities.Thoracoscopic approach to the left pleural cavity was standard. Visualization of the pleural cavity, the mediastinal part of the pericardium was impossible due to the adhesive process. The large adhesion of the parietal and costal pleura was detected. A sequential adhesilysis via monopolar coagulation was performed and anatomical structures as phrenic nerve and pulmonary veins became available to differentiate and observe. Then a longitudinal pericardiotomy was performed and the procedure continued.The same adhesive process involving the costal, mediastinal and parietal pleura was in the right hemithorax.A sequential adhesiolysis was performed via coagulation, then it became possible to perform a right-sided thoracoscopic treatment of atrial fibrillation.RESULTS:The total adhesiolysis time was 82 minutes. The aerostasis after drainage of the pleural cavities was complete. The extubation was 1 hour after surgery.CONCLUSIONS:Even in the case of massive pleural adhesions, thoracoscopic AF ablation is feasible and safe 
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