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Introduction: Although the pericardial window (PW) is used as a diagnostic method for hemopericardium, there is evidence that it can be used as a treatment in patients who present hemodynamic stability. The objective of this work is to describe the PW treatment of 6 patients with hemopericardium due to penetrating trauma admitted at Sótero del Río hospital. Methods: A series of 6 patients were analyzed where PW was used as a therapeutic method between 2022-2023. Results: Of 6 patients analyzed, 5 were admitted for stab wounds and 1 for gunshotwound. All patients are men and the transfer time was less than 10 minutes, 4 patients had an extended focused evaluation with ultrasound in trauma (E-FAST) positive for hemopericardium and 2 doubtful, 5 were managed for subxiphoid PW and 1 for Transdiaphragmatic PW. There was only one conversion to thoracotomy, 1 patient required exploratory laparoscopy due to a left thoracoabdominal injury and 1 patient required exploratory laparotomy due to liver trauma with active bleeding in the same surgery. The maximum hospitalization time was 10 days. All patients underwent follow-up by echocardiography, which was normal. Conclusion: Pericardial window treatment of hemopericardium due to penetrating trauma is feasible. However, it must be carried out in a highly protocolized center [ABSTRACT FROM AUTHOR]

Objective: This study compared outcomes in patients with solid tumor treated for pericardial effusion with surgical drainage versus interventional radiology (IR) percutaneous drainage and compared incidence of paradoxical hemodynamic instability (PHI) between cohorts. Background: Patients with advanced-stage solid malignancies may develop large pericardial effusions requiring intervention. PHI is a fatal and underreported complication that occurs following pericardial effusion drainage. Methods: Clinical characteristics and outcomes were compared between patients with solid tumors who underwent surgical drainage or IR percutaneous drainage for pericardial effusion from 2010 to 2020. Results: Among 447 patients, 243 were treated with surgical drainage, of which 27 (11%) developed PHI, compared with 7 of 204 patients (3%) who were treated with IR percutaneous drainage (P=0.002); overall incidence of PHI decreased during the study period. Rates of reintervention (30-day: 1% vs 4%; 90-day: 4% vs 6%, P=0.7) and mortality (30-day: 21% vs 17%, P=0.3; 90-day: 39% vs 37%, P=0.7) were not different between patients treated with surgical drainage and IR percutaneous drainage. For both interventions, OS was shorter among patients with PHI than among patients without PHI (surgical drainage, median [95% confidence interval] OS, 0.89 mo [0.33-2.1] vs 6.5 mo [5.0-8.9], P<0.001; IR percutaneous drainage, 3.7 mo [0.23-6.8] vs 5.0 mo [4.0-8.1], P=0.044). Conclusions: With a coordinated multidisciplinary approach focusing on prompt clinical and echocardiographic evaluation, triage with bias toward IR percutaneous drainage than surgical drainage and postintervention intensive care resulted in lower incidence of PHI and improved outcomes. [ABSTRACT FROM AUTHOR]

To compare short-term outcomes of CT-guided percutaneous pericardial drainage (PPD) versus subxiphoid surgical pericardial window (PW) drainage and analyze the risk factors associated with their outcomes. A retrospective chart review of patients who underwent either percutaneous drainage with drainage catheter placement or PW with surgical drain placement for symptomatic pericardial effusion between January 1, 2006 and August 31, 2016 was performed after institutional review board approval (decision number 16-783). The primary objective was to test for associations between the short-term (≤30 days post procedure) complication and recurrence rates in patients with symptomatic pericardial effusions. The secondary objectives were to test for associations between short-term complications with changes in vital signs. Of the 257 procedures included in the final analysis, 142 were in the percutaneous drainage group. Short-term complication rate was significantly greater (p < 0.001) in patients undergoing PW, 17% (19/114), as compared with PPD, 2% (3/142). The estimated odds of having complications in the PW cohort was 9 times greater than the percutaneous drainage cohort (OR = 9.3, 95% CI: 2.7-32.3). No significant difference was observed between whether or not a patient experienced a short-term recurrence and any of the explanatory variables (patient demographics, imaging, and vital signs). CT-guided PPD is a safer alternative to surgical PW as it leads to fewer complications without a significant difference in recurrence rate of pericardial effusion. [ABSTRACT FROM AUTHOR]

Introduction: Rhodococcus is an extremely rare, gram positive, aerobic, coccobacillary organism, usually found in the soil or in dairy and livestock animals. It is most commonly affecting the immunocompromised. Only 15 % of cases have been reported in immunocompetent hosts. Case report: We bring forth the unusual case of a 45-year-old gem minor who had already undergone pericardial window due to pericardial effusion. He presented to us with recurrent pericardial effusion and anterior mediastinal mass diagnosed on Computed Tomography Pulmonary Angiogram scan. He was diagnosed with Rhodococcus as being the causative organism of the condition on pericardial fluid cultures. This is an extremely rare manifestation of Rhodococcus infection, which has not yet been reported in literature to the best of our knowledge. Discussion: The first human case of Rhodococcus was reported in a young male upon steroidal therapy for autoimmune hepatitis who developed pneumonia in 1967. Rhodococci infections are usually common in immunocompromised hosts, and only 19 cases have been reported in immunocompetent hosts till now. The usual signs of presentation are cough, pleuritic chest pain, and fever; however, it varies according to the site of infection. The most common manifestation is pneumonia, although other presentations include osteomyelitis, brain abscess, wound infections, etc. Result: The diagnosis and treatment of Rhodococci is very difficult due to the rarity of presentation. Despite that, surgical intervention should be considered as the preferred modality for diagnostic purposes and in infections resistant to medical management.

Chylopericardium is very rarely encountered in clinical practice. The common causes are post cardiac or thoracic surgery and neoplasms of the mediastinum. Most of the time, no cause is attributed and it is labelled as primary idiopathic chylopericardium. Conservative management is usually not successful and definitive surgery is required. The recommended surgery is creation of a pericardio-pleural window and thoracic duct ligation. We demonstrate that this procedure can be easily accomplished by uniportal video-assisted thoracic surgery (U-VATS). [ABSTRACT FROM AUTHOR]

We conducted a meta‐analysis to assess the diagnostic performance of chest ultrasound compared with a pericardial window for the detection of occult penetrating cardiac wounds in patients with penetrating thoracic trauma who were hemodynamically stable. A systematic literature search up to December 2022 was performed and 567 related studies were evaluated. The chosen studies comprised 629 penetrating thoracic trauma subjects who participated in the selected studies' baseline. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated to assess the effect of different chest ultrasounds on wound infection after penetrating thoracic trauma by the dichotomous methods with a random or fixed effect model. The chest ultrasound resulted in significantly lower occult penetrating cardiac wounds detection (OR, 0.02; 95% CI, 0.01–0.08, P < 0.001), higher false positive (OR, 33.85; 95% CI, 9.21–124.39, P < 0.001), and higher false negative (OR, 27.31; 95% CI, 7.62–97.86, P < 0.001) compared with the pericardial window in penetrating thoracic trauma. The chest ultrasound resulted in significantly lower occult penetrating cardiac wound detection, higher false positives, and higher false negatives compared with the pericardial window in penetrating thoracic trauma. Although care should be taken when dealing with the results because all of the studies had less than 200 subjects as a sample size [ABSTRACT FROM AUTHOR]

Abstract Background Pericardial effusions with its potential life threatening progression towards cardiac tamponade have to be often managed with surgical intervention. In our case study we describe a complication after a common surgical procedure which has only scarce literature mentions. Case presentation We present a case of a 22-year-old male patient who underwent subxiphoidal pericardial fenestration, due to symptomatic pericardial effusion with the Chamberlain procedure and biopsy of enlarged mediastinal lymph nodes. The histology report confirmed classical Hodgkin lymphoma and subsequently the patient underwent oncological treatment. Later on he was admitted to the hospital with dyspnoea and chest pain. The initial examinations stated a suspicion for intrathoracic tumour arising from the pericardium or liver. Further investigation revealed symptomatic intrathoracic liver herniation for which the patient underwent laparoscopic surgery with the mobilisation of liver and placement of a perforated Parietene™ composite mesh. Conclusion The purpose of this case report is to describe a rare complication after pericardial fenestration with its potential clinical implications.

Background: Management of penetrating chest injuries with a positive pericardial window (PW) are presumed cardiac injuries and traditionally result in sternotomy. However, there is some evidence in the literature that select patients can be managed with PW, lavage, and drainage (PWLD). Methods: All patients with penetrating chest trauma who underwent PW and/or sternotomy over a 5-year period were identified. Patients were stratified by operative intervention [PW + sternotomy vs PWLD] and compared. Multivariable logistic regression (MLR) analysis was performed to determine independent predictors of therapeutic sternotomy. Results: Of the 146 patients who underwent PW and/or sternotomy included in the study, 126 patients underwent PW, 39 underwent sternotomy, and 10 underwent PWLD. There was no difference in demographics, LOS, ICU LOS, vent days, or mortality in patients who underwent PW + sternotomy, compared to patients who underwent PWLD. In the PWLD group, one patient returned to the OR for recurrent pericardial effusion and no patients required sternotomy. Multivariable logistic regression identified ISS as an independent predictor of therapeutic sternotomy (OR 1.160; 95% CI 1.006-1.338, P =.0616). Interestingly, positive FAST, significant CT findings, and trajectory were not predictors of therapeutic sternotomy. There were 7 patients with a left hemothorax and negative FAST found to have a positive PW and cardiac injury mandating sternotomy and repair. Conclusion: Penetrating cardiac injury can be managed with PWLD in select patients. Positive FAST, significant findings on CT, and trajectory do not mandate sternotomy. A negative FAST in the setting of a hemothorax does not rule out a cardiac injury. [ABSTRACT FROM AUTHOR]

Background: Pericardial effusions with its potential life threatening progression towards cardiac tamponade have to be often managed with surgical intervention. In our case study we describe a complication after a common surgical procedure which has only scarce literature mentions. Case presentation: We present a case of a 22-year-old male patient who underwent subxiphoidal pericardial fenestration, due to symptomatic pericardial effusion with the Chamberlain procedure and biopsy of enlarged mediastinal lymph nodes. The histology report confirmed classical Hodgkin lymphoma and subsequently the patient underwent oncological treatment. Later on he was admitted to the hospital with dyspnoea and chest pain. The initial examinations stated a suspicion for intrathoracic tumour arising from the pericardium or liver. Further investigation revealed symptomatic intrathoracic liver herniation for which the patient underwent laparoscopic surgery with the mobilisation of liver and placement of a perforated Parietene™ composite mesh. Conclusion: The purpose of this case report is to describe a rare complication after pericardial fenestration with its potential clinical implications. [ABSTRACT FROM AUTHOR]

The clinical features of severe hypothyroidism vary in presentation, ranging from subclinical symptoms to multiorgan failure referred to as myxedema coma. The cornerstone treatments of myxedema coma include aggressive thyroid hormone replacement combined with excellent supportive care in the intensive care unit. We report a rare case of a 56-year-old female with history of hypothyroidism treated with levothyroxine, who developed myxedema coma post-pericardial window surgery for a large pericardial effusion. She was supported with substantial doses of vasopressors and inotropes for shock. In addition, she was initiated on lung-protection ventilation for acute respiratory distress syndrome. After the diagnosis of myxedema coma was made, she was started on intravenous levothyroxine and hydrocortisone with great sustained clinical response. This case illustrated myxedema coma as an unusual cause of shock in post-operative patients with past medical history of hypothyroidism. [ABSTRACT FROM AUTHOR]

Purpose of Review: To summarize the contemporary practice of pericardiectomy and pericardial window. We discuss the indications, preoperative planning, procedural aspects, postprocedural management, and outcomes of each procedure. Recent Findings: Surgical approaches for the treatment of pericardial disease have been around even before the emergence of cardiopulmonary bypass. Since the forthcoming of cardiopulmonary bypass, there have been significant changes in the epidemiology and diagnostic approach of pericardial diseases as well as advancements in the surgical techniques and perioperative management used in the care of these patients. Summary: Pericardiectomy has an average mortality of almost 7% and is typically performed in patients with advanced symptoms from constrictive pericarditis and relatively few comorbidities. Pericardial window is a safe procedure for the treatment of pericardial effusion that can be performed with different approaches. [ABSTRACT FROM AUTHOR]

Bacterial pericarditis is a rare yet fatal form of pericarditis. With the introduction of antibiotics, incidence of bacterial pericarditis has declined to 1 in 18,000 hospitalized patients. In this report, we present a rare case of MSSA pericarditis in a patient that presented with systemic lupus erythematosus flare, which required treatment with antibiotics and source control with pericardial window and drain placement.

Penetrating cardiac injuries (PCIs) have high in-hospital mortality rates. Guidelines regarding the use of pericardial window (PW) for diagnosis and treatment of suspected PCIs are not universally established. The objective of this review was to provide a critical appraisal of the current literature to determine the effectiveness and safety of PW as both a diagnostic and therapeutic technique for suspected PCIs in patients with hemodynamic stability. A review was conducted using PubMed/MEDLINE, Google Scholar, and Embase to identify literature evaluating the accuracy and therapeutic efficacy of PW and its role in a hemodynamically stable patient with penetrating thoracic or thoracoabdominal trauma. Eleven studies evaluating diagnostic PW and two studies evaluating therapeutic PW were included. These studies ranged from (y) 1977 to 2018. Existing literature indicates that PW is highly sensitive (92%-100%) and specific (96%-100%) for the diagnosis of suspected PCIs. PW and drainage, when compared with sternotomy, may be associated with decreased total hospital stay (4.1 versus 6.5 d; P < 0.001) and intensive care unit stay (0.25 versus 2.04 d; P < 0.001) along with similar mortality and complication rates after the management of hemopericardium. In a hemodynamically stable patient presenting with penetrating cardiac trauma with a high suspicion for PCI, PWs can (1) facilitate prompt diagnosis in the event of equivocal ultrasonography findings and (2) serve as an effective therapeutic modality with the benefit of potentially avoiding more invasive procedures. Subxiphoid, transdiaphragmatic, and laparoscopic approaches for PW have been shown to have similar efficacy and safety. [ABSTRACT FROM AUTHOR]

Introduction: Rhodococcus is an extremely rare, gram positive, aerobic, coccobacillary organism, usually found in the soil or in dairy and livestock animals. It is most commonly affecting the immunocompromised. Only 15 % of cases have been reported in immunocompetent hosts., Case Report: We bring forth the unusual case of a 45-year-old gem minor who had already undergone pericardial window due to pericardial effusion. He presented to us with recurrent pericardial effusion and anterior mediastinal mass diagnosed on Computed Tomography Pulmonary Angiogram scan. He was diagnosed with Rhodococcus as being the causative organism of the condition on pericardial fluid cultures. This is an extremely rare manifestation of Rhodococcus infection, which has not yet been reported in literature to the best of our knowledge., Discussion: The first human case of Rhodococcus was reported in a young male upon steroidal therapy for autoimmune hepatitis who developed pneumonia in 1967. Rhodococci infections are usually common in immunocompromised hosts, and only 19 cases have been reported in immunocompetent hosts till now. The usual signs of presentation are cough, pleuritic chest pain, and fever; however, it varies according to the site of infection. The most common manifestation is pneumonia, although other presentations include osteomyelitis, brain abscess, wound infections, etc., Result: The diagnosis and treatment of Rhodococci is very difficult due to the rarity of presentation. Despite that, surgical intervention should be considered as the preferred modality for diagnostic purposes and in infections resistant to medical management., Competing Interests: No conflict., (© 2024 The Author(s).)

Background For the management of pericardial effusion, pericardiocentesis plays an essential role. Despite advanced imaging methods, a substantial risk of complication persists. Objectives We aimed to predict the risk factors of pericardiocentesis complicated by cardiac injury and to assess the surgical outcome in complicated cases after echo-guided drainage. Patients and methods This observational study enrolled 134 patients with pericardial effusion who were scheduled for pericardiocentesis for drainage. The patients were divided into two groups: group I comprised 21 patients who required surgical intervention, and group II included 113 patients with successful uncomplicated pericardiocentesis. Results The mean age was 47.49±16.38 years, and 52.2% were males. There were no significant differences between both groups regarding the patients’ characteristics. Hemodynamic instability was higher in the complicated (71.4%) than the noncomplicated (20.4%) group. Recurrent pericardiocentesis trials (≥2) were statistically higher in group I than group II (P<0.0001). The most common ethology was uremia, with no statistically significant difference between both groups. Multivariate analysis revealed that hemodynamic instability, more than two pericardiocentesis trial, and loculated effusion could predict cardiac injury during pericardiocentesis (odds ratio and 95% confidence interval were 24.206 and 3.632–161.315, 212.227, and 16.049–2806.445, and 16.113 and 1.765–147.058, respectively). Conclusions The presence of loculated effusion, hemodynamic instability, and the recurrence of effusion as two or more pericardiocentesis trials were potential risk factors of cardiac injury during pericardiocentesis. A pericardial window in high-risk cases is advised as a safe treatment procedure. [ABSTRACT FROM AUTHOR]

Hypothyroidism is a condition characterized by low thyroid hormone levels that can affect multiple organ systems with varying symptomatology. Common cardiac manifestations of hypothyroidism include bradycardia and decreased cardiac output. Pericardial effusion can also occur as a result of the condition and rarely can progress to cardiac tamponade. Patients with cardiac tamponade occurring as a result of underlying hypothyroidism can present atypically compared to those experiencing cardiac tamponade due to other causes. Patients with cardiac tamponade as a result of underlying hypothyroidism may present as minimally symptomatic with stable vital signs. Close monitoring of patients with pericardial effusions with underlying hypothyroidism is essential to permit early diagnosis and treatment of the condition. We outline the case of a 73-year-old male presenting with cardiac tamponade due to underlying hypothyroidism necessitating an urgent pericardial window., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Badhey et al.)

Competing Interests: No conflicts to disclose.

Chylopericardium is a rare and benign condition. Apart from common causes like non-surgical trauma, tuberculosis, malignancy, radiation, and postoperative, mediastinal cystic hygroma presenting as chylopericardium is an extremely rare entity. Primary or idiopathic chylopericardium is diagnosed when the precise cause is not known. It is a diagnosis of exclusion. We report a 27-year-old lady with mediastinal cystic hygroma, presenting as spontaneous chylopericardium, who was managed surgically with no recurrence on 18 months follow-up. She was evaluated for complaints of discomfort in the upper abdomen region and breathing difficulty in left lateral position for 4 days, and was found to have a large pericardial effusion with impending tamponade. She underwent pericardiocentesis, and on fluid analysis, it was confirmed as chylous pericardial effusion. She was evaluated thoroughly and was taken up for right video-assisted thoracoscopy. The thoracic duct was clipped and a window was created in the pericardium, the cystic hygroma was excised, and pleurodesis was done. The postoperative period was uneventful. Histopathology of the pericardial window showed chronic inflammatory pathology and cystic lesion was confirmed as a chylous cyst. [ABSTRACT FROM AUTHOR]

Tension pneumomediastinum is a rare complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that has increased in incidence with the novel coronavirus disease 2019 pandemic. Although traditionally managed with conservative measures, we present the indications and methods for the first operative management of tension pneumomediastinum with concomitant SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

Abstract Tension pneumomediastinum is a rare complication of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection that has increased in incidence with the novel coronavirus disease 2019 pandemic. Although traditionally managed with conservative measures, we present the indications and methods for the first operative management of tension pneumomediastinum with concomitant SARS‐CoV‐2 infection.

Background Amoebiasis is a prevalent infection in the tropics. Amoebic liver abscess is the most common extraintestinal manifestation. Cardiac tamponade is an uncommon complication of amoebic liver abscess that may need urgent pericardiocentesis. Case summary A 25-year-old man presented with abdominal pain and fever for 1 month. Abdominal ultrasound revealed a 4.7 × 4.7 cm abscess in the left lobe of the liver. Percutaneous pigtail drainage was performed to evacuate the abscess. After 2 days, the patient developed signs of cardiac tamponade and bilateral pleural effusion, requiring urgent pericardiocentesis and chest drain insertion. Persistent posterior collection of thick abscess in pericardium needed pericardial window for complete drainage. The patient recovered completely after pericardial window. There was no evidence of chronic constrictive pericarditis after 1 year of follow-up. Discussion A rare complication of the amoebic liver abscess was observed in this young adult who developed cardiac tamponade, requiring an urgent pericardiocentesis, and later requiring pericardial window. Management includes amoebicidal and luminicidal drugs for complete eradication of Entamoeba histolytica. [ABSTRACT FROM AUTHOR]

The optimal surgical technique for drainage of pericardial effusions is frequently debated. Transpleural drainage via thoracotomy or thoracoscopy is hypothesized to provide more durable freedom from recurrent pericardial effusion than a subxiphoid pericardial window. We sought to compare operative outcomes and mid-term freedom from recurrent effusion between both approaches in patients with nontraumatic pericardial effusions. All patients at our institution who underwent a pericardial window from 2001 to 2018 were identified. After excluding those who underwent recent cardiothoracic surgery or trauma, patients (n = 46) were stratified by surgical approach and presence of malignancy. Primary outcome was freedom from recurrent moderate or greater pericardial effusion. Secondary outcomes included operative mortality and morbidity and mid-term survival. Follow-up was determined by medical record review, with a follow-up of 67 patient-years. Fisher's exact test and Wilcoxon rank-sum test were used to compare groups. Mid-term survival and freedom from effusion recurrence were determined using Kaplan–Meier method. Subxiphoid windows (n = 31; 67%) were more frequently performed than transpleural windows (n = 15; 33%) and baseline characteristics were similar. Effusion etiologies included malignancy (n = 22; 48%), idiopathic (n = 12; 26%), uremia (n = 8; 17%), and collagen vascular disease (n = 4; 9%). Perioperative outcomes were comparable between the two surgical approaches, except for longer drain duration (7 versus 4 d, P = 0.029) in the subxiphoid group. Operative mortality was 19.6% overall and 36.4% in patients with malignancy. Mid-term survival and freedom from moderate or greater pericardial effusion recurrence was 37% (95% confidence interval [CI]: 19%-54%) and 69% (95% CI: 52%-86%) at 5 y, respectively. There was no difference in mid-term survival (P = 0.90) or freedom from pericardial effusion recurrence (P = 0.70) between surgical approaches. Although malignant etiology had worse late survival (P < 0.01), freedom from effusion recurrence was similar to nonmalignant etiology (P = 0.70). Pericardial window provides effective mid-term relief of pericardial effusion. Subxiphoid and transpleural windows are equivalent in mid-term efficacy and both surgical approaches can be considered. Patients with malignancy have acceptable operative mortality with low incidence of recurrent effusion, supporting palliative indications. [ABSTRACT FROM AUTHOR]

Aim: In this study, we aimed to investigate the superiority of right pericardial window (RPW) versus posterior pericardial drain placing for the parameters of pericardial effusion and the postoperative complications at the patients who has undergone cardiac surgery. Materials and methods: Between July and September 2018, 120 adult patients (mean age 50.30 ± 14.61) who underwent cardiac surgery without the necessity of opening the pleura were included in the study. In Group 1, the RPW was opened (n = 60), and Group 2 posterior pericardial drainage tube was placed without RPW (n = 60). Risk factors and postoperative complication were evaluated and compared between the Groups. Results: Cardiac tamponade occurrence was not significantly different between the Groups (Group 1, n = 0 and Group 2, n = 3, p = 0.079). Postoperative transthoracic echocardiographic controls revealed significant pericardial effusion in Group 2 (6.90 mm ± 13.02 mm) compared to Group 1 (2.30 mm ± 5.60 mm) (p = 0.013). Postoperative creatinine levels were 0.75 ± 0.26 in Group 1 and 0.88 ± 0.36 in Group 2 (p = 0.022). A significant decrease in glomerular filtration rate was observed in Group 2 (102.7 ± 24.5 and 91.2 ± 28, p = 0.019). Postoperative acute renal failure was significantly higher in Group 2 compared to Group 1 (p < 0.001). Postoperative new onset atrial fibrillation occurred in 4 patients in Group 1 and 8 in Group 2 (p = 0.224). The duration of intensive care unit stay was 36.00 ± 22.31 h in Group 1 and 53.60 ± 59.50 h in Group 2 (p = 0.034). Development of pneumothorax, pneumonia and pleural effusion were not statistically different between the Groups (p = 0.079, 0.171, 0.509). Conclusion: RPW application is more effective on preventing postoperative complications in cardiac surgery instead of placing drains in posterior pericardium. [ABSTRACT FROM AUTHOR]

Penetrating cardiac injury is rare and historically known to have very poor prognosis. Even today, 90 % of patients die before arriving to hospital. Even though patient presentations can be atypical, organized timely intervention can lead to survival. A 21 years old arrived 5 h after stab injury to right anterior chest. He was hypotensive with a sucking wound bleeding on his right chest as well as hemothorax on the same side. Chest tube and pericardial window were both done with blood in pericardial space. Median sternotomy was done and revealed right atrial perforation. The perforation was repaired and the patient was discharged and continues to do well on follow up. For most patients, time from injury to surgery is short. Focused and organized surveys as well as resuscitation are valuable for any patent with penetrating thoracic trauma. With a patient in hemorrhagic shock and a penetrating wound near the heart, a pericardial window is required regardless of the absence of pericardial fluid on ultrasound and in this case proved to be lifesaving. If there is a hole in the pericardium communicating with the pleural space the pericardial blood may decompress into the pleural cavity and not be visible on ultrasound. Regardless of its rare prevalence, high index of suspicion for cardiac injury is extremely important in all patients with penetrating chest trauma in the cardiac box regardless of atypical presentations. With rapid diagnosis, capable surgeon availability, and availability of blood products, patients can survive this injury. • Penetrating cardiac injury is rare accounting only 0.1% of most trauma admissions. • Patients commonly present with shock and tamponade. Delayed presentation is rare because most patients don't arrive to hospitals. • high index of suspecion for cardiac injury is extremly important even in atypically presented patients. • Median sternotomy is best and reasonable approach for penetrating cardiac injuries. • Proper implementation of ATLS principles can lead to survival even in resource limited settings. [ABSTRACT FROM AUTHOR]

Abstract Background Trauma characteristics and its management is influenced by socioeconomic context. Cardiac trauma constitutes a challenge for surgeons, and outcomes depend on multiple factors including initial care, characteristics of the wounds, and surgical management. Methods This is a retrospective cross-sectional case series of patients with penetrating cardiac injuries (PCI) from January 1999 to October 2009 who underwent surgery in a trauma referral center in Bogotá, Colombia. Demographic variables, trauma characteristics, treatment, and outcomes were analyzed. Results The study included 240 cases: 96.2% males, mean age of 27.8 years. Overall mortality was 14.6%: 11.7% from stab wounds and 41.2% from gunshot wounds. Upon admission, 44% had a normal hemodynamic status and 67% had cardiac tamponade. About 32% had Grade II injuries and 29% Grade IV injuries. In 85% of the cases, there were ventricular compromise and 55% of patients had associated lesions. In 150 cases, a pericardial window was performed. Highest mortality occurred in wounds to the right atrium. In tamponade patients, mortality was 20% being higher for gunshot wounds (54.5%) than for stab wounds (18%) (p = 0.0120). Conclusions The study evidenced predominance of stab wounds. Based on characteristics of the trauma, patients, and survival rate, there is most likely a high pre-hospitalization mortality rate. The difference in mortality due to stab wounds and those produced by gunshots was more related to technical difficulties of the surgical repair than with the type of injury established by the Injury Grading Scale. Mortality was higher in patients with cardiac tamponade. Surgical management was satisfactory using pericardial window as the diagnostic method and sternotomy as the surgical approach.

Objective: Malignant pericardial effusion (MPE) is uncommon in advance stage cancer. However, it could cause a life-threatening condition such as cardiac tamponade. Surgical drainage is routinely recommended as a rapid and effective treatment in this disease. This study aims to investigate an overall outcome after pleuro-pericardial window surgery in MPE patients. Materials and Methods: From 2007 to 2017, 32 MPE patients who underwent pleuro-pericardial window were enrolled. Benign pericardial disease or patients who receive only pericardiocentesis or pericardial sclerosing agent were excluded. Baseline clinical data such as sex, primary cancer, complication rate and result of pathological from pericardial biopsy were collected, retrospectively. Overall survival (OS) was analyzed by the Kaplan-Meier method and log-rank test. Results: There were 18 male patients with mean age of 55 years old. The majority of primary cancers was lung cancer, followed by breast cancer. Mean overall survival was 3.7 months. There was no recurrence. Overall survival at 30-day mortality, 3 months and 1 year were 75%, 59% and 19%, respectively. In subgroup analysis, there was no difference in overall survival between lung cancer and non-lung cancer group (p = 0.650). Conclusion: Pleuro-pericardial window is a safe and effective procedure with low recurrence rate. However, decision-making should be made individually for each patient. [ABSTRACT FROM AUTHOR]

Pericardial effusion can lead to cardiac tamponade requiring immediate management. Pericardial windows are an effective measure to surgically drain recurrent effusions. We present a case of a 53-year-old male with recurrent pericardial effusion secondary to ESRD and exacerbated by COVID-19 infection, describing the successful management of an uncommon clinical scenario. A sub-xiphoid pericardial window and right sided thoracostomy was performed. There are limited case reports highlighting recurrent pericardial effusion management, secondary to ESRD and COVID-19 in a post renal transplant patient, through a subxiphoid pericardial window. COVID-19 infection can exacerbate pericardial effusion in a patient with ESRD, post renal transplant. Preventing cardiac tamponade, a sub-xiphoid pericardial window remains an effective measure in treating recurrent pericardial effusion. • Pericardial window is an effective measure, treating recurrent pericardial effusion. • COVID-19 exacerbates pericardial effusion in renal transplant patients with ESRD. • Long-term effectiveness of pericardial drains is unknown. [ABSTRACT FROM AUTHOR]

Supravalvular pulmonary stenosis acquired as a postoperative cardiac procedure complication is relatively common. However, that occurring after a surgically created pleuro‐pericardial window has not been described until now, to the best of our knowledge. We present a case of acquired supravalvular pulmonary stenosis that developed 9 years after the pleuro‐pericardial window creation for pyopericardium due to a constricting pericardial band. The child underwent successful surgical relief of the stenosis along with repair of the atrial and ventricular septal defects. [ABSTRACT FROM AUTHOR]