Balkhy Husam H, Patel Brooke B, Spiller Robert, Avella-Patino Diego
Department of Surgery, Section of Cardiac and Thoracic Surgery, University of Chicago Medicine, IL, USA.
Department of Cardiothoracic Surgery, St. Louis University, MO, USA.
Innovations (Phila). 2019 Oct;14(5):468-472. doi: 10.1177/1556984519861960. Epub 2019 Jul 24.
Acute, relapsing pericarditis is an uncommon potential complication of any cardiothoracic intervention. If medical management fails to mitigate recurrent symptoms, robotic total pericardiectomy can be performed as a definitive therapeutic option. A 33-year-old woman had severely symptomatic, persistent pericarditis, which began 3 weeks after pacemaker placement for tachy-brady syndrome. After failure of pharmacologic treatment, a robot-assisted total pericardiectomy was performed with a drastic improvement in symptoms. Considering that this case of pericarditis was inflammatory (nonconstrictive), a radical excisional approach to all the pericardium was undertaken in order to prevent relapse of symptoms. A bilateral endoscopic off-pump robot-assisted approach was used to completely and fully excise both the anterior and posterior pericardium. In conclusion, we present a case of acute relapsing pericarditis in a very symptomatic patient who failed medical therapy and underwent a robotic totally endoscopic radical pericardiectomy with excellent results. We believe that this technique allows for total pericardiectomy using the least invasive approach and should be considered in the management of this rare but potentially debilitating condition.
急性复发性心包炎是任何心胸介入手术中一种罕见的潜在并发症。如果药物治疗无法缓解复发症状，机器人辅助全心包切除术可作为一种确定性治疗选择。一名33岁女性患有严重症状性持续性心包炎，在因心动过速-心动过缓综合征植入起搏器3周后发病。药物治疗失败后，实施了机器人辅助全心包切除术，症状得到显著改善。鉴于该例心包炎为炎症性（非缩窄性），为防止症状复发，对所有心包采用了根治性切除方法。采用双侧内镜非体外循环机器人辅助方法，完全彻底切除前后心包。总之，我们报告了一例症状非常严重的急性复发性心包炎患者，其药物治疗失败，接受了机器人辅助全内镜根治性心包切除术，效果极佳。我们认为，该技术可采用创伤最小的方法进行全心包切除术，在这种罕见但可能使人衰弱的疾病的治疗中应予以考虑。
