Figure 1. (right) One lung ventilation – This procedure requires the use of a special anesthetic technique called one lung ventilation where one side of the lung is deliberately collapsed to allow more room to operate in the chest cavity. With careful monitoring this is a very useful and safe technique.
Patches, a 5 year old English Springer Spaniel
Patches, a 5 year old English Springer Spaniel, presented to our clinic due to coughing and shortness of breath. Patches chest radiographs revealed that he had a build of fluid in his chest (pleural effusion) that was preventing his lungs from expanding normally. He was referred to our cardiologists who did an echocardiographic examination which revealed that he was suffering from a disease known as restrictive pericarditis. In this condition the sac that normally suspends the heart within the chest cavity becomes thickened and fibrous and prevents the heart from expanding normally. The result is an inability of the heart to allow normal flow of blood into the heart resulting in a build of “back-pressure” in front of the heart. The result is that fluid leaks out of the blood vessels and accumulates within the chest and abdominal cavities which eventually restricts breathing. The treatment for this condition is to remove the entire pericardial sac from around the heart. Using thoracoscopic access to the chest we were able to resect the entire pericardial sac and remove it from the body. After the surgery we were able to prove that we had relieved the abnormal pressure within the heart by passing catheters into the chambers of the heart and measuring the relevant pressure profiles.
Figure 2. (left) Half way through the procedure the removal of the pericardial sac from one side is complete. Now the other side will be cut just below the level of the phrenic nerves to ensure there is no remaining pericardial tissue to constrict the heart.
Figure 3. The completed subtotal pericardectomy. The entire pericardium has been removed.