Successful use of thoracoscopic pericardiectomy in elderly patients with massive pericardial effusion caused by uremic pericarditis

We report the use of thoracoscopic pericardiectomy to treat two elderly pat ients with massive pericardial effusion caused by uremic pericarditis. A 79 -year-old man, admitted to our hospital complaining of dyspnea, was diagnos ed with end-stage renal failure and began maintenance hemodialysis, Althoug h intensive hemodialysis was performed, the patient could not remain on hem odialysis because of severe hypotension during the procedure. Echocardiogra phy revealed massive pericardial effusion and severe hypokinesis of the lef t ventricular wall, Pericardiocentesis was performed first, without success , followed by thoracoscopic pericardiectomy under general anesthesia. One m onth after the pericardiectomy, episodes of hypotension during hemodialysis improved, and dyspnea diminished. Echocardiography showed no pericardial e ffusion and improvement of left ventricular wall motion. Pericarditis is a fatal complication in patients with end-stage renal failure and patients on maintenance hemodialysis. The second patient received the same procedure w ith a similar improvement of clinical symptoms. These cases suggest that th oracoscopic pericardiectomy is a safe and effective treatment of pericardia l effusion caused by uremic pericarditis in elderly patients on hemodialysi s. (C) 2001 by the National Kidney Foundation, Inc.