Abstract Introduction. One of the most common pathologies of the pericardium is pericarditis, which can present as acute, subacute or chronic pericarditis, pericardial effusion, cardiac tamponade or constrictive pericarditis. However, it is a rare condition in the pediatric population. Methods. A series of cases of patients with pericarditis who were taken to pericardiotomy, pericardial drainage and anterior partial pericardiectomy, between July 2014 and June 2023 is presented. Demographic and clinical variables were collected, microbiological isolates and the management received were evaluated. Results. A total of 12 patients underwent minimally invasive surgical management; of these, 58% belonged to indigenous communities and lived in rural areas. Half had associated pneumonia. In most cases, no microbiological isolation was obtained. Conclusion. The need for surgical management is determined by the impact on the hemodynamic variables related to the effusion and pericardial compromise. Partial pericardiectomy by thoracoscopy is an alternative in these cases.

Resumen Introducción. Una de las patologías más frecuentes del pericardio es la pericarditis, que puede presentarse como pericarditis aguda, subaguda o crónica, derrame pericárdico, taponamiento cardíaco o pericarditis constrictiva. Sin embargo, es una condición infrecuente en la población pediátrica. Métodos. Presentamos una serie de casos de pacientes con pericarditis que fueron llevados a pericardiotomía, drenaje pericárdico y pericardiectomía parcial anterior, entre julio de 2014 y junio de 2023. Se recolectaron las variables demográficas y clínicas, se evaluaron los aislamientos microbiológicos y el manejo recibido. Resultados. Un total de 12 pacientes fueron llevados a manejo quirúrgico mínimamente invasivo; de estos, 58 % pertenecían a comunidades indígenas y residían en zonas rurales. La mitad tenían neumonía asociada. En la mayoría de los casos no se obtuvo aislamiento microbiológico. Conclusión. La necesidad de manejo quirúrgico está determinada por la repercusión en las variables hemodinámicas relacionadas con el derrame y el compromiso pericárdico. La pericardiectomía parcial por toracoscopia es una alternativa en estos casos.

ABSTRACT The case of a 10-year-old Golden Retriever dog treated at the ASMEVET veterinary hospital in the city of Tunja, Colombia is presented. The owner reported that the patient had an intermittent cough for 2 months. The physical examination revealed the patient to be hyperactive, body condition 4/5, and faint heart sounds. Echocardiography, chest xray, and electrocardiogram were performed, revealing pericardial effusion, increased size of the cardiac silhouette, and deviation of the S-T segment. Initially, treatment was attempted with antibiotics, diuretics and anti-inflammatory agents, without a favourable response. Two months later, it was necessary to perform emergency pericardiocentesis due to cardiac tamponade, and partial subphrenic pericardiectomy. Histopathological analysis revealed a paraganglioma. The patient survived 673 days after surgical treatment.

RESUMEN Se presenta el caso de un canino de 10 años de edad, raza Golden Retriever, atendido en el hospital veterinario ASMEVET en la ciudad de Tunja, Colombia. El propietario reportó que el paciente tubo tos intermitente desde hace 2 meses. Al examen físico se evidencia al paciente hiperactivo, condición corporal 4/5, y con sonidos cardíacos apagados. Se realiza ecocardiografía, radiografía de tórax, y electrocardiograma, encontrando efusión pericárdica, aumento de tamaño de la silueta cardiaca y desviación del segmento S-T. Inicialmente se intentó tratar con antibiótico, diurético y antiinflamatorio, sin respuesta favorable. Dos meses después fue necesario realizar pericardiocentesis de urgencia por el taponamiento cardíaco, y pericardiectomía subfrénica parcial. El análisis histopatológico dio como resultado un paraganglioma. El paciente logra sobrevivir 673 días después del tratamiento quirúrgico.

Abstract Primary cardiac tumors are rare. The cardiac sarcomas are the most common malignant cardiac tumors. These tumors have a dismal prognosis with an overall median survival of 25 months. Clinical features include dyspnea, arrhythmias, pericardial effusions, heart failure, and sudden cardiac death. The diagnosis is often challenging. Therefore, the cardiac imaging workup plays a central role in addition to a high clinical suspicion in the setting of atypical presentations that do not respond to standard therapies. The echocardiography, computed tomography, and cardiac MRI are crucial in clinching the diagnosis. Multimodal treatment with surgery, chemotherapy, and radiotherapy has been shown to improve outcomes, as opposed to using either of these modalities alone. We describe the case of a 30-year-old gentleman with COVID-19 infection who developed recurrent hemorrhagic pericardial effusions refractory to standard treatment and was eventually diagnosed as a case of pericardial angiosarcoma after his biopsy revealed the diagnosis and staging was performed using PET–CT–FDG scan. Our case re-emphasizes the importance of considering a malignant etiology early in the course of the disease presentation, especially in recurrent hemorrhagic effusions despite an inflammatory cytologic diagnosis of fluid. It also highlights the place for cardiac CT and MRI to ascertain the location and spread and to plan the further course of treatment. If diagnosed early, the estimated survival time can be prolonged by instituting a multimodal approach.

ABSTRACT Hydatidosis or echinococcosis is an endemic parasitic disease caused by the ingestion of eggs of echinococcal species worldwide. In India, the annual incidence varies from 1 to 200 per one 100,000 hab., with the highest prevalence reported in the Indian states of Andhra Pradesh and Tamil Nadu. The dog is the definitive host, while humans, sheep, and cattle are intermediate hosts. The disease usually involves the liver and lungs, with the kidney and other organs rare involvement. Cardiac hydatidosis is still further rare, seen in 0.2% to 2% of the patients who remain asymptomatic until the development of its complications. Sudden deaths in cardiac echinococcosis are mostly attributed to cardiac arrhythmias, coronary artery diseases, valvular diseases, cardiomyopathies, pericarditis, and cardiac tamponade. We, herein, report a rare case of cardiac hydatid cyst incidentally found during the autopsy of a 26-year-old male who died due to electrical injuries. A single greyish-white cystic mass measuring 1.5cm X 1.2cm was detected on the left anterior ventricular wall 4 cm above the apex and was confirmed microscopically as a hydatid cyst. The cause of death was attributed to external injury.

ABSTRACT Circulatory shock is a common fatal condition. Despite this, information on this syndrome in the current medical literature is fragmented and esoteric. Adherence to each basic element of care can have a profound impact on patient outcomes. Disturbances in pumping (cardiogenic), content/container relationship (hypovolemic and vasoplegic), or blockage in blood circulation (obstructive) can induce tissue hypoperfusion, causing hemodynamic shock. If not quickly reversed, hypoperfusion progresses to irreversible multi-organ failure. The course can be fatal even before reaching this stage in cases of obstructive and anaphylactic shock in which the therapeutic window may last for only a few minutes. Thus, it is essential to conduct a joint analysis of clinical data and routine diagnostic tests to infer the probable cause of shock and avoid delays in the diagnosis of diseases that can deteriorate quickly. Point-of-care ultrasonography and echocardiography are the most valuable non-invasive diagnostic tools. Although lactate-guided management has proven to be effective, the use of capillary refill time, other biochemical markers of perfusion, and preload-directed resuscitation have the potential to avoid volume overload and improve outcomes. Faster intravenous fluid infusion and early use of vasopressors have a strong rational appeal. However, in hemorrhagic shock, finding a balance between avoiding excessive crystalloid administration and maintaining adequate perfusion pressure until hemostasis is achieved remains challenging. This review provides an accessible description of bedside management of shock, including the treatment of the main causes. The most relevant information has been organized into tables for quick reference. condition esoteric outcomes cardiogenic, cardiogenic , (cardiogenic) contentcontainer content container hypovolemic vasoplegic, vasoplegic vasoplegic) (obstructive reversed multiorgan multi organ failure minutes Thus Pointofcare Point noninvasive non invasive tools lactateguided lactate guided effective time preloaddirected preload directed appeal However challenging causes reference (cardiogenic

ABSTRACT Introduction: Acute aortic dissection Stanford type A (AADA) is a surgical emergency associated with high morbidity and mortality. Although surgical management has improved, the optimal therapy is a matter of debate. Different surgical strategies have been proposed for patients under 60 years old. This paper evaluates the postoperative outcome and the need for secondary aortic operation after a limited surgical approach (proximal arch replacement) vs. extended arch repair. Methods: Between January 2000 and January 2018, 530 patients received surgical treatment for AADA at our hospital; 182 were under 60 years old and were enrolled in this study - Group A (n=68), limited arch repair (proximal arch replacement), and group B (n=114), extended arch repair (> proximal arch replacement). Results: More pericardial tamponade (P=0.005) and preoperative mechanical resuscitation (P=0.014) were seen in Group A. More need for renal replacement therapy (P=0.047) was seen in the full arch group. Mechanical ventilation time (P=0.022) and intensive care unit stay (P<0.001) were shorter in the limited repair group. Thirty-day mortality was comparable (P=0.117). New onset of postoperative stroke was comparable (Group A four patients [5.9%] vs. Group B 15 patients [13.2%]; P=0.120). Long-term follow-up did not differ significantly for secondary aortic surgery. Conclusion: Even though young patients received only limited arch repair, the outcome was comparable. Full-arch replacement was not beneficial in the long-time follow-up. A limited approach is justified in the cohort of young AADA patients. Exemptions, like known Marfan syndrome and the presence of an intimal tear in the arch, should be considered. Introduction (AADA improved debate 6 vs Methods 200 2018 53 hospital 18 n=68, n68 n n=68 , 68 (n=68) replacement, n=114, n114 n=114 114 (n=114) > ( replacement. . Results P=0.005 P0005 P 0 005 (P=0.005 P=0.014 P0014 014 (P=0.014 P=0.047 P0047 047 (P=0.047 P=0.022 P0022 022 (P=0.022 P<0.001 P0001 001 (P<0.001 Thirtyday Thirty day P=0.117. P0117 P=0.117 117 (P=0.117) 5.9% 59 5 9 [5.9% 1 13.2% 132 13 2 [13.2%] P=0.120. P0120 P=0.120 120 P=0.120) Longterm Long term followup follow up surgery Conclusion Fullarch Full longtime long followup. up. Exemptions considered 20 201 n6 n=6 (n=68 n11 n=11 11 (n=114 P=0.00 P000 00 (P=0.00 P=0.01 P001 01 (P=0.01 P=0.04 P004 04 (P=0.04 P=0.02 P002 02 (P=0.02 P<0.00 (P<0.00 P011 P=0.11 (P=0.117 5.9 [5.9 13.2 [13.2% P012 P=0.12 12 n= (n=6 n1 n=1 (n=11 P=0.0 P00 (P=0.0 P<0.0 (P<0.0 P01 P=0.1 (P=0.11 5. [5. 13. [13.2 (n= (n=1 P=0. P0 (P=0. P<0. (P<0. (P=0.1 [5 [13. (n P=0 (P=0 P<0 (P<0 [ [13 P= (P= P< (P< [1 (P

ABSTRACT Introduction: Pericardial effusion is a common complication without a standard postoperative effusion treatment after cardiac surgery. The grooved negative pressure drainage tube has many advantages as the emerging alternative for drainage of pericardial effusion, such as it changes the structure of the traditional side hole, uses the capillary function to ensure drainage smooth, etc. The purpose of this study was to assess the feasibility and effectiveness of transthoracic color Doppler ultrasound-guided grooved negative pressure drainage tube implantation in pericardial effusion after cardiac surgery. Methods: All patients with pericardial effusion after cardiac surgery who underwent transthoracic color Doppler ultrasound-guided grooved negative pressure drainage tube implantation between January 2019 and December 2021 were retrospectively analyzed. Treatment results (including clinical symptoms, effusion volume, color Doppler ultrasonography, and computed tomography scan) were investigated to evaluate the effectiveness and safety of this method. Results: A total of 20 patients successfully underwent transthoracic color Doppler ultrasound-guided grooved negative pressure drainage tube implantation. After the operation, their symptoms (chest tightness, shortness of breath, etc.) were all relieved, and dark red or light red drainage fluid (> 200 ml) appeared in the newly placed drainage bottle. Color Doppler ultrasonography showed that the volume of pericardial effusion decreased significantly. Conclusion: The transthoracic color Doppler ultrasound-guided grooved negative pressure drainage tube is a safe and effective method for the treatment of postoperative pericardial effusion with less trauma, faster recovery, shorter in-hospital stay, and fewer complications.

ABSTRACT Pericardial tuberculosis (TBP) is a rare manifestation of extrapulmonary tuberculosis (TB). It presents insidiously and nonspecifically, making diagnosis difficult and delaying treatment, leading to serious complications such as pericardial effusion with signs of cardiac tamponade or constrictive pericarditis. The case of an 18-year-old female patient, pregnant, with a history of close contact with a relative with pulmonary TB is described; she consulted the Emergency Service for dyspnea. Among the studies requested, the echocardiogram showed pericardial effusion with compression of cavities, requiring pericardiocentesis. Pericardial fluid culture revealed Mycobacterium tuberculosis and antituberculous treatment plus corticosteroids were started. It evolved with a recurrence of effusion despite adequate medical treatment and the performance of a pericardial window.

RESUMEN La tuberculosis pericárdica es una manifestación poco frecuente de la tuberculosis extrapulmonar. Se presenta de manera insidiosa e inespecífica, lo que dificulta el diagnóstico, retrasa el tratamiento, y lleva a complicaciones graves, como el derrame pericárdico con signos de taponamiento cardíaco o pericarditis constrictiva. Se describe el caso de una paciente femenina de 18 años, embarazada, con antecedente de contacto estrecho con familiar con tuberculosis pulmonar, que consultó al servicio de urgencias por disnea. Entre los estudios solicitados, el ecocardiograma evidenció la presencia de un derrame pericárdico con compresión de cavidades, por lo que requirió pericardiocentesis. El cultivo del líquido pericárdico informó Mycobacterium tuberculosis y se inició tratamiento antituberculosis y corticoides. Evolucionó con recurrencia del derrame a pesar de tratamiento médico adecuado y realización de ventana pericárdica.

ABSTRACT Pericardial tuberculosis (TBP) is a rare manifestation of extrapulmonary tuberculosis (TB). It presents insidiously and nonspecifically, making diagnosis difficult and delaying treatment, leading to serious complications such as pericardial effusion with signs of cardiac tamponade or constrictive pericarditis. The case of an 18-year-old female patient, pregnant, with a history of close contact with a relative with pulmonary TB is described; she consulted the Emergency Service for dyspnea. Among the studies requested, the echocardiogram showed pericardial effusion with compression of cavities, requiring pericardiocentesis. Pericardial fluid culture revealed Mycobacterium tuberculosis and antituberculous treat ment plus corticosteroids were started. It evolved with a recurrence of effusion despite adequate medical treatment and the performance of a pericardial window.

RESUMEN La tuberculosis pericárdica es una manifestación poco frecuente de la tuberculosis extrapulmonar. Se presenta de manera insidiosa e inespecífica, lo que dificulta el diagnóstico, retrasa el tratamiento, y lleva a complicaciones graves, como el derrame pericárdico con signos de taponamiento cardíaco o pericarditis constrictiva. Se describe el caso de una paciente femenina de 18 años, embarazada, con antecedente de contacto estrecho con familiar con tuberculosis pulmonar, que consultó al servicio de urgencias por disnea. Entre los estudios solicitados, el ecocardiograma evidenció la presencia de un derrame pericárdico con compresión de cavidades, por lo que requirió pericardiocentesis. El cultivo del líquido pericárdico informó Mycobacterium tuberculosis y se inició trata miento antituberculosis y corticoides. Evolucionó con recurrencia del derrame a pesar de tratamiento médico adecuado y realización de ventana pericárdica.

ABSTRACT Introduction: Pericardial effusion is a common complication without a standard postoperative effusion treatment after cardiac surgery. The grooved negative pressure drainage tube has many advantages as the emerging alternative for drainage of pericardial effusion, such as it changes the structure of the traditional side hole, uses the capillary function to ensure drainage smooth, etc. The purpose of this study was to assess the feasibility and effectiveness of transthoracic color Doppler ultrasound-guided grooved negative pressure drainage tube implantation in pericardial effusion after cardiac surgery. Methods: All patients with pericardial effusion after cardiac surgery who underwent transthoracic color Doppler ultrasound-guided grooved negative pressure drainage tube implantation between January 2019 and December 2021 were retrospectively analyzed. Treatment results (including clinical symptoms, effusion volume, color Doppler ultrasonography, and computed tomography scan) were investigated to evaluate the effectiveness and safety of this method. Results: A total of 20 patients successfully underwent transthoracic color Doppler ultrasound-guided grooved negative pressure drainage tube implantation. After the operation, their symptoms (chest tightness, shortness of breath, etc.) were all relieved, and dark red or light red drainage fluid (> 200 ml) appeared in the newly placed drainage bottle. Color Doppler ultrasonography showed that the volume of pericardial effusion decreased significantly. Conclusion: The transthoracic color Doppler ultrasound-guided grooved negative pressure drainage tube is a safe and effective method for the treatment of postoperative pericardial effusion with less trauma, faster recovery, shorter in-hospital stay, and fewer complications. Introduction hole smooth etc ultrasoundguided ultrasound guided Methods 201 202 analyzed including scan Results 2 operation chest tightness breath relieved > ( ml bottle significantly Conclusion trauma recovery inhospital hospital stay complications

ABSTRACT Introduction: Our study aimed to examine the impacts of blood cardioplegia (BC) and del Nido cardioplegia (DNC) solutions - which we used in isolated coronary artery bypass grafting (CABG) - on early mortality and major adverse events (MAE). Methods: We retrospectively analyzed 329 consecutive patients who underwent CABG in our clinic between January 2016 and January 2020. Myocardial infarction, reoperation, cardiac tamponade, stroke, renal failure, extracorporeal membrane oxygenation requirement, and cardiopulmonary resuscitation were defined as MAE. The group in which DNC was used was Group D (181 [55%] patients), and the group in which BC was used was Group B (141 [45%] patients). Results: No statistically significant difference was determined between the groups regarding age, weight, body surface area, gender, or European System for Cardiac Operative Risk Evaluation score (P=0.615, P=0.560, P=0.934, P=0.365, P=0.955, respectively). Although there was no statistically significant difference between the groups in terms of aortic cross-clamping time (P=0.712), cardiopulmonary bypass duration was longer in Group B (P=0.001). Even though the incidence of stroke was higher in Group B (P=0.030), no statistically significant difference was observed between the groups regarding total incidence of MAE, mortality, mechanical ventilation time, length of stay in the intensive care unit, or length of hospital stay (P=0.153, P=0.130, P=0.689, P=0.710, P=0.613, respectively). Conclusion: We found no significant difference in MAE, mortality, duration of mechanical ventilation, intensive care unit stay, or hospital stay between the DNC and BC groups. We believe that both solutions can be used safely for cardiac protection in the adult patient population. Introduction (BC (DNC (CABG MAE . (MAE) Methods 32 201 2020 infarction reoperation tamponade failure requirement 181 (18 55% 55 [55% patients, , patients) 141 (14 45% 45 [45% patients. Results age weight area gender P=0.615, P0615 P 0 615 (P=0.615 P0560 560 P=0.560 P0934 934 P=0.934 P0365 365 P=0.365 P0955 955 P=0.955 respectively. respectively respectively) crossclamping cross clamping P=0.712, P0712 P=0.712 712 (P=0.712) P=0.001. P0001 P=0.001 001 (P=0.001) P=0.030, P0030 P=0.030 030 (P=0.030) P=0.153, P0153 153 (P=0.153 P0130 130 P=0.130 P0689 689 P=0.689 P0710 710 P=0.710 P0613 613 P=0.613 Conclusion population (MAE 3 20 202 18 (1 5 [55 14 4 [45 P=0.615 P061 61 (P=0.61 P056 56 P=0.56 P093 93 P=0.93 P036 36 P=0.36 P095 95 P=0.95 P071 P=0.71 71 (P=0.712 P000 P=0.00 00 (P=0.001 P003 P=0.03 03 (P=0.030 P=0.153 P015 15 (P=0.15 P013 13 P=0.13 P068 68 P=0.68 P=0.61 2 1 ( [5 [4 P06 6 (P=0.6 P05 P=0.5 P09 9 P=0.9 P03 P=0.3 P07 P=0.7 7 (P=0.71 P00 P=0.0 (P=0.00 (P=0.03 P=0.15 P01 (P=0.1 P=0.1 P=0.6 [ P0 (P=0. P=0. (P=0.7 (P=0.0 (P=0 P=0 (P= P= (P

Resumo Fundamento A janela pericárdica, além de promover a drenagem pericárdica, também pode fornecer amostras do pericárdio para exame anatomopatológico. No entanto, a contribuição dessas biópsias para a elucidação da etiologia do derrame pericárdico tem sido debatida. Objetivo Analisar o valor diagnóstico da biópsia pericárdica não guiada obtida de procedimentos de janela pericárdica. Métodos Foram revisados retrospectivamente dados de 80 pacientes submetidos a biópsia pericárdica parietal de 2011 a 2020. A significância estatística foi considerada quando p < 0,05. Resultados Cinquenta pacientes eram do sexo masculino (62,5%) e 30 do sexo feminino (37,5%). A mediana de idade foi de 52 anos (intervalo interquartil: 29 a 59) e 49 anos (intervalo interquartil: 38 a 65), respectivamente (p = 0,724). A etiologia suspeita do derrame pericárdico foi neoplásica em 31,3%, incerta em 25%, tuberculose em 15%, autoimune em 12,5%, síndrome edemigênica em 7,5% e outras condições diversas em 8,8%. A abordagem mais frequente para drenagem pericárdica e biópsia foi a subxifoide (74%), seguida pela videotoracoscopia (22%). Em 78,8% das biópsias, os achados histopatológicos foram compatíveis com inflamação inespecífica, e apenas 13,7% de todas as biópsias produziram um diagnóstico histopatológico conclusivo. Aqueles que sofriam de câncer e derrame pericárdico apresentaram maior proporção de achados histopatológicos conclusivos (32% apresentavam infiltração neoplásica pericárdica). A taxa de mortalidade hospitalar foi de 27,5% e 54,5% dos pacientes que morreram no hospital tinham câncer. Nenhuma morte foi atribuída ao tamponamento cardíaco ou ao procedimento de drenagem. Conclusão Nossos resultados mostraram que a janela pericárdica é um procedimento seguro, mas teve pouco valor para esclarecer a etiologia do derrame pericárdico e nenhum impacto na terapia planejada para o diagnóstico primário além da descompressão cardíaca. anatomopatológico entanto debatida 8 201 2020 005 0 05 0,05 62,5% 625 62 5 (62,5% 3 37,5%. 375 37,5% . 37 (37,5%) intervalo interquartil 2 59 4 65, 65 , 65) 0,724. 0724 0,724 724 0,724) 313 31 31,3% 25 25% 15 15% 125 12 12,5% 75 7 7,5 88 8,8% 74%, 74 74% (74%) 22%. 22 22% (22%) 788 78 78,8 inespecífica 137 13 13,7 conclusivo 32% 32 (32 pericárdica) 275 27 27,5 545 54 54,5 seguro cardíaca 20 202 00 0,0 62,5 6 (62,5 37,5 (37,5% 072 0,72 72 31,3 1 12,5 7, 8,8 (74% (22% 78, 13, (3 27, 54, 0, 62, (62, 37, (37,5 07 0,7 31, 12, 8, (74 (22 ( (62 (37, (7 (2 (6 (37

Abstract Background Pericardial window, in addition to promoting pericardial drainage, can also provide samples of the pericardium for anatomopathological examination. However, such biopsies’ contribution to clarifying the etiology of pericardial effusion has been debated. Objective To analyze the diagnostic value of non-targeted pericardial biopsy obtained from pericardial window procedures. Methods Data from 80 patients who had undergone parietal pericardial biopsies from 2011 to 2020 were retrospectively reviewed. Statistical significance was considered if p < 0.05. Results Fifty patients were male (62.5%,) and 30 were female (37.5%). The median age was 52 years (interquartile range: 29 to 59) and 49 years (interquartile range: 38 to 65), respectively (p = 0.724). The suspected etiology of pericardial effusion was neoplastic in 31.3%, unclear in 25%, tuberculosis in 15%, autoimmune in 12.5%, edemagenic syndrome in 7.5%, and other miscellaneous conditions in 8.8%. The most frequent approach for pericardial drainage and biopsy was subxiphoid (74%), followed by video-assisted thoracoscopy (22%). Overall, in 78.8% of the biopsies, the histopathologic findings were compatible with nonspecific inflammation, and only 13.7% of all biopsies yielded a conclusive histopathological diagnostic. Those suffering from cancer and pericardial effusion had a higher proportion of conclusive histopathologic findings (32% had pericardial neoplastic infiltration). The hospital mortality rate was 27.5%, and 54.5% of the patients who died in the hospital had cancer. No deaths were attributed to cardiac tamponade or the drainage procedure. Conclusion Our results showed that pericardial window is a safe procedure, but it had little value to clarify the pericardial effusion etiology and no impact on the planned therapy for the primary diagnosis besides the cardiac decompression. examination However debated nontargeted non targeted procedures 8 201 202 reviewed 005 0 05 0.05 62.5%, 625 62 5 (62.5%, 3 37.5%. 375 37.5% . 37 (37.5%) interquartile range 2 59 4 65, 65 , 65) 0.724. 0724 0.724 724 0.724) 313 31 31.3% 25 25% 15 15% 125 12 12.5% 75 7 7.5% 88 8.8% 74%, 74 74% (74%) videoassisted video assisted 22%. 22 22% (22%) Overall 788 78 78.8 inflammation 137 13 13.7 32% 32 (32 infiltration. infiltration infiltration) 275 27 27.5% 545 54 54.5 procedure decompression 20 00 0.0 62.5% 6 (62.5% 37.5 (37.5% 072 0.72 72 31.3 1 12.5 7.5 8.8 (74% (22% 78. 13. (3 27.5 54. 0. 62.5 (62.5 37. (37.5 07 0.7 31. 12. 7. 8. (74 (22 ( 27. 62. (62. (37. (7 (2 (62 (37 (6

Resumen: Aunque su uso sólo está indicado para el acceso a venas centrales en medicina humana, en el presente reporte describimos la implantación de un dispositivo Port-a-Cath en el espacio pericárdico de una hembra canina de la raza Ovejero Alemán. Esta paciente fue diagnosticada de un hemangiosarcoma en la pared auricular derecha y a consecuencia de la colecta pericárdica padeció signos de taponamiento cardíaco previamente a la implantación del dispositivo. La técnica utilizada supuso una dificultad quirúrgica media y ofreció un acceso percutáneo a la cavidad pericárdica de forma permanente tanto para la aspiración de la colecta como para la administración de Cisplatino, el cual se administró en una sola dosis a los 7 días post implantación. Se realizaron controles semanales de permeabilidad y posicionamiento del dispositivo, sin verificar colecta pericárdica hasta el día 52 de implantado en el que comenzó nuevamente a colectar cantidades que variaban entre 15 y 50 ml de líquido serosanguinolento. Este fue fue aspirado con intervalos de 3 días hasta que el animal fue eutanasiado de forma compasiva en el día 68. El dispositivo Port-a-Cath se mantuvo permeable, no se evidenciaron complicaciones asociadas al mismo, ni migraciones hacia la cavidad pleural. Una vez eutanasiada la paciente, se realizó una toracotomía con el fin de enviar muestras de tejido al laboratorio de histopatología donde se confirmó el diagnóstico de hemangiosarcoma. Al comprobarse la existencia de múltiples metástasis en pulmones, resto del corazón, pericardio y tejido subcutáneo y a través de la sintomatología asociada a disnea en reposo, se pudo concluir que la paciente no falleció por taponamiento cardíaco, sino por el tumor y sus agregados metastásicos. El implante de un dispositvo Port-a-Cath mostró ser una alternativa para la prevención del taponamiento cardíaco de origen maligno en esta paciente canina.

Abstract: Although its use is only indicated for access to central veins in human medicine, we describe the implantation of a Port-a-Cath device in the pericardial space of a female German Sheperd dog. This patient was diagnosed with a hemangiosarcoma in the right atrial wall and as a result of the pericardial effusion the dog suffered signs of cardiac tamponade prior to the implantation of the device. The technique supposed a medium surgical difficulty and offered percutaneous access to the pericardial cavity permanently both for the aspiration of the effusion and for the administration of Cisplatin, which was administered in a single dose 7 days after implantation. Weekly controls of permeability and positioning of the device were carried out, without verifying pericardial effusion until day 52 after implantation, in which the patient began to collect amounts of fluid with a range of 15 to 50 ml. This was aspirated with intervals of 3 to 5 days until the animal was compassionately euthanized on day 68. The Port-a-Cath device remained permeable, there were no complications associated with it, nor migrations into the pleural cavity. Once the patient was euthanized, a thoracotomy was performed in order to have the final histopathology diagnosis in which hemangiosarcoma was confirmed. The existence of multiple metastasis in the lungs, rest of the heart, pericardium and subcutaneous tissue, and the symptoms associated with dyspnea at rest, helped to conclud that the patient did not die from cardiac tamponade, but from the tumor and its metastasis. The implantation of a Port-a-Cath device proved to be an alternative for the prevention of malignant cardiac tamponade in this canine patient.

Resumo: Embora seu uso seja indicado apenas para acesso às veias centrais na medicina humana, no presente relato descrevemos o implante de dispositivo Port-a-Cath ou cateter totalmente implantado no espaço pericárdico de um canino da raça Pastor Alemão. O paciente foi diagnosticado com hemangiossarcoma em parede de átrio direito e, em decorrência da efusão pericárdica, apresentou sinais de tamponamento cardíaco prévios ao implante do dispositivo. A técnica utilizada foi de média dificuldade cirúrgica e proporcionou acesso percutâneo permanente à cavidade pericárdica tanto para aspiração da efusão pericárdica quanto para administração de cisplatina, que foi administrada em dose única 7 dias após o implante. Foram realizadas provas semanais de permeabilidade e posicionamento do dispositivo, sem produção de efusão pericárdica até o dia 52 após o implante, quando voltou a produzir quantidades que variaram entre 15 e 50 ml de líquido serosanguinolento. Tal efusão foi aspirada em intervalos de 3 a 5 dias até que o animal fosse eutanasiado no dia 68. O dispositivo Port-a-Cath permaneceu funcional, não havendo complicações nem migrações para a cavidade pleural. Após a eutanásia do paciente, foi realizada toracotomia para envio de amostras ao laboratório de histopatologia, onde foi confirmado o diagnóstico de hemangiossarcoma. Concluimos que a causa do quadro clínico de dispneia em repouso, incompatível com a vida, foi a existência de múltiplas metástases nos pulmões, coração, pericárdio e tecido subcutâneo pelo quadro avançado do hemangiossarcoma, descartando tamponamento cardíaco como causa da morte. O implante do dispositivo Port-a-Cath mostrou-se uma alternativa para a prevenção do tamponamento cardíaco de origem maligna neste paciente canino.

Abstract: Introduction: Cardiac injuries represent a group of pathologies within thoracic trauma that often result in fatal hemorrhage. These types of injuries can be contained by the membrane surrounding the heart, allowing enough time for the patient to receive emergency treatment. Case report: We present two patients with stab wounds to the thorax. The first patient presented wounds to the anterior and posterior wall of the right ventricle and an injury to the diaphragm and liver. The second patient was admitted with a left ventricle wound very close to the anterior descending artery and a left lung laceration. Both cases underwent emergency surgery, and sutures were performed both in cardiac cavities and injured structures with favorable evolution. At the present date, they are still alive with no cardiovascular complications.

Resumen: Introducción: Las lesiones cardiacas constituyen un grupo de patologías dentro del trauma torácico que muchas veces resultan en hemorragia fatal. Este tipo de lesiones pueden ser contenidas por la membrana que rodea el corazón, lo que genera suficiente tiempo para que el paciente reciba tratamiento de emergencia. Presentación de caso: Presentamos dos pacientes con heridas de arma blanca en el tórax. El primer paciente presentó heridas en la pared anterior y posterior del ventrículo derecho, además de lesión en el diafragma y el hígado. El segundo paciente ingresó con una herida en el ventrículo izquierdo muy cerca de la arteria descendente anterior y también presentó una laceración del pulmón izquierdo. Ambos casos fueron intervenidos de urgencia, realizándose suturas tanto en cavidades cardiacas como en estructuras lesionadas con evolución favorable. En la actualidad, siguen vivos sin complicaciones cardiovasculares.