Pericardiectomía anterior por toracoscopia en un hospital de segundo nivel

Objective. Describe one case of a patient who developed a cardiac tamponade, that was solved by an anterior pericardiectomy using thoracoscopic approach. Design. Report of one case. Place. General Hospital (second level). Description of the case. The treatment of a 20 years old male with the following antecedents related to his pathology: three years of evolution of nephrotic syndrome, developing an uremic pericarditis secondary to a chronic renal failure, besides a one year evolution of a hypertensive cardiopathy; the patient was also in a program of ambulatory peritoneal dialysis. The patient was admitted to the hospital presenting vomitus, respiratory failure, pericardiac friction and jugular enlargement. The next laboratory tests were included: PA thoracic radiography presenting grade IV cardiomegaly, echocardiogram reporting constrictive trabecular pericardial effusion; General Surgery consultation was requested for pericardiac window and/or pericardiectomy by sternotomy, minimal access thoracic surgery approach was suggested, performing anterior pericardiectomy by thoracoscopic access, draining 1400 c.c of intrapericardiac hemorrhagic fluid and placing a pleurostomy probe in left hemithorax, eliminating cardiac symptomatology and removing the water seal at the sixth day of the postoperative. The patient egresses asymptomatic of the cardiac problem and with improvement of his azoic levels. The histopatologic inform reported a possible nodose polyarteritis and fibrin conglomerate. Conclusion. Thoracoscopic approach is a good and new surgical option to perform an anterior pericardiectomy in patients with constrictive uremic pericarditis.