Pericardial effusion is the most prevalent pericardial disease process in dogs, reported in 7% of dogs with clinical signs of cardiac disease. Accumulation of fluid within the pericardial sac can lead to an equilibration between intrapericardial and intracardiac pressures, with subsequent cardiac tamponade, decreased cardiac output, and eventual cardiogenic shock. Various etiologies of pericardial effusion have been identified, the most common including neoplastic and idiopathic diseases. Pericardectomy can be indicated to palliate neoplastic effusions or as definitive treatment for idiopathic effusions and restrictive pericarditis.
Subtotal pericardectomy (STP) involves removal of the pericardium ventral to the phrenic nerves and has traditionally been performed to address pericardial effusion. This procedure can be performed after median sternotomy to allow concurrent visualization of both phrenic nerves. Alternative surgical approaches include right lateral thoracotomy or a transdiaphragmatic approach. Thoracotomy allows direct exposure and extensive excision of the pericardium, but the invasive nature of such approach may increase the risk of complications and morbidity compared to minimally invasive surgery.
The potential complications of thoracoscopy are similar to those of a thoracotomy but were less frequent in one study. This study evaluated postoperative pain and morbidity in dogs undergoing open thoracotomy and STP versus a thoracoscopic pericardial window (PW), which involves removal of only a small portion of pericardium to allow for drainage of pericardial fluid. Dogs treated with thoracoscopic PW experienced less postoperative pain, fewer wound complications, and a more rapid return to function.
Based on these findings, a minimally invasive procedure may also decrease hospitalization time, which is especially relevant in dogs with neoplastic pericardial effusion in light of their limited survival time.
For complete details on this topic please check out our case study: https://vetmedaz.com/wp-content/uploads/2018/01/VetMed-epicardial-exposure.pdf.
VedMed’s very own MaryAnn Radlinsky, DVM, MS, DACVS, helped to co-author the case study. Dr. Radlinsky studied at Cornell University and specializes in Small Animal Soft Tissue Surgery and Minimally Invasive Surgery. Additionally, Dr. Radlinsky is an ACVS Founding Fellow, Minimally Invasive Surgery, Small Animal Soft Tissue.