Purpose: We present our experience in performing thoracoscopic pericardiectomy for purulent pericarditis
in 21 children.
Materials and Methods: Pericardiectomy was carried out using one optical trocar and two operating
trocars. Pleural insufflation with carbon dioxide was maintained at 2–4 mm Hg. Anterior pericardiectomy
was performed from the left phrenic nerve to the right border of the sternum to free
the anterior part of the heart, notably the cardiac apex and the original area of the great vessels.
Purulent debris was removed prior to detaching the epicardial peel.
Results: This study included 21 patients. Their mean age was 8 years. The time from onset of the
disease to surgery ranged from 4 to 34 days (average, 15.2 days). Operative times ranged from 50
to 180 minutes (average, 100 minutes). There were no intraoperative or postoperative complications.
All symptoms of cardiac tamponade disappeared immediately postoperatively. Follow-up ranged
from 4 to 15 months and showed normal clinical manifestations, echocardiographs, and chest x-rays
in all children.
Conclusion: Thoracoscopic pericardiectomy with removal of a generous amount of the pericardium
is feasible and safe for purulent pericarditis.
