There does not appear to be a need for more invasive procedures, such as a thoracotomy or pericardial window
, given the success and lack of complications with minimally invasive techniques.
Abdominal ultrasound demonstrated a flattened IVC and significant abdominal ascites, so a subxiphoid pericardial window
(to exclude pericardial tamponade) was performed and bilateral thoracostomy tubes were placed to ensure that extrinsic compression was not the cause of right atrial underfilling.
Before a pericardial window
could be performed, the patient suffered a cardiac arrest requiring a bedside pericardiocentesis which yielded 850 cc of bloody fluid and a prolonged resuscitation effort.
Loculated effusions and effusions containing clots increase the risks of closed pericardiocentesis, mainly perforation of the ventricle; in these instances an open approach is more desirable, both for safety and to obtain pericardial tissue and create a pericardial window
He underwent a pericardial window
with catheter drainage, and 400 ml of old clotted blood was withdrawn.
A pericardial window
was offered to the patient, given the large amount of effusion present and the need for a definitive diagnosis of the atrial mass that could be accomplished by biopsy, considering that the patient also had a remote history of melanoma with some minimal lymphatic invasion, which had been excised previously.
Surgeon Performs World's First Pericardial Window
Please see "Delayed Hemopericardium After Penetrating Chest Trauma: Thoracoscopic Pericardial Window
as a Therapeutic Option" on page 994 of this issue.
However, among those who reach the hospital, most cardiac injuries are discovered at admission and treated accordingly, whether initially decompressed with a subxiphoid pericardial window
, or approached with an open thoracotomy.