الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Pericardial effusion is abnormal accumulation of fluid within pericardial sac. Etiologies range from infections to malignancies. Effusion is classified based on size, duration, composition and cause. It’s often assessed using echocardiography.
Clinical presentations vary from asymptomatic to severe, including cardiac tamponade, which presents with hypotension, elevated venous pressure and muffled heart sounds. Diagnostic tools include echocardiography, ECG, chest X-ray, CT and MRI.
Management depends on effusion size and cause. Conservative treatment addresses underlying factors and may involve NSAIDs, colchicine, diuretics, antibiotics and analgesics. Pericardiocentesis is indicated for hemodynamic instability, large effusions, or unclear causes, but carries high risk of complications and recurrence rates.
U-VATS has emerged as a crucial advancement in managing recurrent pericardial effusion. The aim of our study was to assess a modified technique for pleuropericardial window creation which entails suturing the pericardial edges to the chest wall. This would prevent future adhesions and establish a durable connection between the pericardial and pleural cavities.
We carried out a prospective analytic study included 10 patients presented with recurrent pericardial effusion. Patients underwent thorough preoperative preparation. The surgery was performed under general anesthesia with single lung ventilation and a single incision of 4-5 cm was made in the 4th or 5th intercostal space. The procedure involved inspection of the thoracic cavity, drainage of pleural effusion if present, identification and opening of the pericardium, drainage of pericardial effusion, pericardial biopsy and the creation of a pleuro-pericardial window. Anchoring the pericardium to the chest wall endothoracic fascia was done. A single chest tube was placed at the end of the operation. Follow-up was conducted for up to 3 months post-operatively to assess various criteria, with particular emphasis on pericardial specimen analysis and effusion recurrence.
The mean age of the patients was 45 ± 12.7 years, primarily females (70%). Dyspnea was the primary presenting symptom for all patients. Preoperative assessments revealed a mean ejection fraction (EF) of 64 ± 5.5 and 30% of cases had preoperative loculated effusion. The right-sided approach was chosen for half of the cases, with an average operative time of 64.2 ± 4.8 minutes. Post-operatively, the duration of intercostal tube drainage ranged from 2 to 5 days, with a mean duration of 3.8 ± 1.1 days and the mean hospital stay was 5.2 ± 1.3 days. Specimen analysis showed malignancy in 50% of cases and there were no recorded post-operative complications or recurrences of pericardial effusion after a 3-month follow-up