BACKGROUND: We present an interesting video of a VATS Redo Pericardial window for a Recurrent Complex Pericardial effusion. Our patient is a 65 year old gentleman, who is a known case of Rheumatoid arthritis and has had recurrent pericardial effusions from 2017. He has already undergone a subxiphoid pericardial window creation in 2017, this was followed by a sternotomy and a redo pericardial window in 2018. He, then recently presented to us with dyspnoea and a recurrent pericardial effusion. His other co-morbidities included a low FEV1 and a Factor V Leiden mutation carrier-requiring long term anticoagulation. He did not want to undergo another open surgery, so we decided to attempt to create a VATS pericardial window.
When we entered the chest, there were dense adhesions, which needed to be taken down. We used, a combination of blunt and sharp dissection to expose sufficient amount of pericardium to create a large enough window for drainage. We had to proceed with great caution while opening the pericardium, as there was a risk of injuring the left ventricle due to multiple previous surgeries in the same area. We were successful in creating a moderate sized window. We placed a surgical drain and completed the procedure.
Recurrent pericardial effusions are commonly seen due to autoimmune diseases, cancer, rare viral and bacterial infections. However, it is extremely important to rule out an underlying malignancy, before we proceed with definitive therapy. Pericardial window is a time-tested and proven treatment for recurrent pericardial effusions. With minimally invasive surgery, it can be performed even in complex cases and relatively unfit surgical candidates with less morbidity and earlier discharge compared to conventional open surgery.
