Teknik Operasi Pericardial Window Lius

8/12/2019 Teknik Operasi Pericardial Window Lius

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Teknik Operasi Perikardiostomi

Presentan:Lius Marson Ling

Pembimbing:

dr. Rama N, Sp.BTKV


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Surgical procedure to create a window from

the pericardial space to the pleural cavity.

The excision of a portion of the pericardium,

which allows the effusion to drain

continuously into the peritoneum or chest.

Stuart J. Hutchison (10 December 2008). Pericardial diseases: clinical diagnostic imaging atlas. Elsevier

Health Sciences. pp. 93
http://books.google.com/books?id=7mZS5PS97X4C&pg=PA93http://books.google.com/books?id=7mZS5PS97X4C&pg=PA93


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via a smallsubxiphoid

incision

thoracoscopically via a thoracotomy

The fluid canbe drained in

any of 3

ways:


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Indications


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Indications

Cardiac tamponade (CT)

Symptomatic pericardial effusions

Asymptomatic pericardial effusions thatwarrant a pericardial window for diagnosis

Hemodynamically stable patients with an

undiagnosed pericardial effusion Coexisting pericardial, pleural, or pulmonary

pathology that requires diagnosis or therapy


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Known benign effusions that reaccumulate

after aspiration

Drainage of a purulent pericardial effusion

Loculated effusions situated unilaterally or

posteriorly

Chylopericardium Delayed hemopericardium or effusions after

cardiac surgery

Indications


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In 1935, Beck described diagnostic triad for CT

Decreasing arterial pressure1

Increasing venous pressure2

Quiet heart3

Hasan Ali Gumrukcuoglu, Dolunay Odabasi Management of Cardiac Tamponade: A Comperative Study between Echo-

Guided Pericardiocentesis and Surgery A Report of 100 Patients. Cardiology Research and Practice. Volume 2011. 19 June

2011.


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Clinical signs in patient with CT include :

Hypotension,

Tachycardia,

Pulsus paradoxus,

Raised jugular venous pressure,

Muffled heart sounds,

Decreased electrocardiographic voltage, and

Enlarged cardiac silhouette on chest x-rays



2011.


9/23http://www.meddean.luc.edu/lumen/MedEd/Radio/curriculum/Medicine/Pericardial_effusion2.htm


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Two-dimensional echocardiographic criteria of CT were:

Accumulation of pericardial fluid creates an anechoicspace

Early diastolic collapse of the right ventricle,

Late diastolic collapse of the right or left atrium, and

Plethora of the inferior vena cava with pericardial effusion



2011.


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CT Scan

http://www.meddean.luc.edu/lumen/MedEd/Radio/curriculum/Medicine/Pericardial_effusion2.htm


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Preparation

Anesthesia

For the subxiphoid approach, general anesthesia is

preferred and optimal. May be performed with local anesthesia plus

adequate sedation in the patient with severetamponadewho cannot tolerate general anesthesia

Arterial and central venous pressure monitoring maybe needed intraoperatively, as well as in thepostoperative period, to guide hemodynamicmanagement.

Darroch W. O. Moores, MD, Keith B. Allen, MD. Subxiphoid pericardial drainage for pericardial tamponade.J Thorac Cardiovasc Surg1995


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For the subxiphoid approach, the patient is

placed in the supine position.

Positioning


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Teknik

M.I.A. Muhammad. Interactive CardioVascular and Thoracic Surgery 12 (2011) 174178

Dale K Mueller, MD; Chief Editor: Eric H Yang, MD. Pericardial Window. http://emedicine.medscape.com/ Aug 3, 2011Darroch W. O. Moores, MD, Keith B. Allen, MD. Subxiphoid pericardial drainage for pericardial tamponade.J Thorac Cardiovasc Surg1995


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1. A short vertical incision (about 5-8 cm long) is made over the

xiphoid, extending onto the midline of the abdomen

2. The linea alba is incised, and the xiphoid is split or often

completely removed.

3. The retrosternal space is entered by means of finger dissection.


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4. With upward retraction, the distal sternum is elevated, thediaphragmatic aspect of the pericardium is visualized

5. The pericardium is grasped with the hook or Allis clamp,

alternatively, it may be incised directly.

6. The opening in the pericardium is enlarged by sharply incising the

pericardium.


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7. A sucker is inserted into the pericardial space and the fluid aspirated.

8. Fluid is sent for bacteriologic andcytologic analyses

9. Often, this sucker or a finger is used for further dissection of any

adhesions.

10. A biopsy specimen is also taken from the pericardium.

11. After all the fluid has been aspirated, the epicardium is inspected.

12. A finger is introduced into the pericardial space to determine if any

additional adhesions exist and if any nodules are in the pericardium.


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12. Finally, through a separate stab wound, a 28 F chest tube is

inserted into the pericardial space and connected

It is important to place the chest tube through a separate

incision because a chest tube left inthe operative wound can

lead to improper wound healing, woundinfection


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13. the incision is closed in layers with absorbable sutures


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The chest tube is left in placefor 4 to 5 days

after the operation.

The chest tube was removed when the

amount of daily drainage was < 100 ml.


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Komplikasi

Perdarahan

infeksi

Arrhythmia cardiac arrest

mortality


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TERIMA KASIH

Documents

Teknik Operasi Pericardial Window Lius