Eastern Cardiothoracic Surgical Society

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Pericardiodiaphragmatic Hernia Following a Subxiphoid Pericardioperitoneal Window for Recurrent Pericardial Effusion: A Case Report and Literature Review
Ernest G. Chan, Nicholas Baker, Ryan M. Levy.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Objective: We report a minimally invasive surgical technique for the treatment of a pericardiodiaphragmatic hernia following a subxiphoid pericardioperitoneal window (SPPW) and a review of literature. Method: We present a 69 yo female that presented with a pericardiodiaphragmatic hernia. We performed a literature review utilizing the MEDLINE database to all cases of iatrogenic pericardiodiaphragmatic hernia following SPPW. Results: 69 yo female presented with obstruction following a second SPPW for recurrent pericardial effusions. She diagnosed with a pericardiodiaphragmatic hernia (Figure 1A-B) and underwent minimally invasive reduction and repair of the anterior diaphragmatic defect with goretex mesh. She presented to clinic in 1 year with a CT scan showing an intact repair with no evidence of recurrence (Figure 1C-D). We identified an additional 20 cases in the literature with radiographically diagnosed iatrogenic pericardiodiaphragmatic hernias following SPPW (Table 1). Mean age was 60 (range 1-86) with a mean time to presentation of 24.8 +/- 53.8 months. The small bowel was most commonly herniated (14 patients) with 8 patients having multiple structures herniating intrapericardially. Three patients were treated conservatively with one death. The remaining patients underwent surgery (1 thoracotomy, 6 laparoscopic, 11 laparotomy) with no deaths. 8 underwent primary repair of the pericardiodiaphragmatic defect while 10 received a mesh implant. Conclusion: Once identified, patients with pericardiodiaphragmatic hernias should undergo surgical intervention as it is associated with excellent outcomes. Minimally invasive repair can be performed. Due to its anterior location, we recommend the use of mesh for a tension free repair and optimal long-term results.


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