Videopericardioscopia. Como melhorar a eficácia diagnóstica em derrames pericárdicos / Video-assisted pericardioscopy. How to improve diagnostic efficacy in pericardial effusions

RESUMO

OBJECTIVE: To assess, in a prospective way, the experience with video-assisted pericardioscopy obtained in patients with pericardial effusion of unclear etiology in the preoperative period. METHODS: From January 1998 to June 2000, 20 patients were operated upon with the aid of video-assisted pericardioscopy. On echocardiography, 17 of these patients had significant pericardial effusion, and 3 had moderate pericardial effusion. Video-assisted pericardioscopy was performed through a small incision of the Marfan type. RESULTS: The diagnosis of pericardial effusion was established as follows idiopathic in 9 (45 percent) patients, neoplastic in 4 (20 percent), resulting from hypothyroidism in 3 (15 percent), tuberculous in 2 (10 percent), due to cholesterol in 1 (5 percent), and chylopericardial in 1 (5 percent). The biopsy was positive in 30 percent of the patients, and the etiology could not be defined in 45 percent of the patients. CONCLUSION: Video-assisted pericardioscopy proved to be a method with low morbidity and a high index of diagnostic positivity. A high percentage of pericardial effusions are caused by viral infections, which are not diagnosed through current methods, being, therefore, classified as idiopathic