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首页> 外文期刊>Heart Failure Reviews >Pericardioscopy and epi- and pericardial biopsy—a new window to the heart improving etiological diagnoses and permitting targeted intrapericardial therapy
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Pericardioscopy and epi- and pericardial biopsy—a new window to the heart improving etiological diagnoses and permitting targeted intrapericardial therapy

机译:心包镜检查和心外膜和心包活检—改善心脏病的病因学诊断并允许进行有针对性的心包内治疗的新窗口

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摘要

The etiology of pericardial effusions remains unresolved in many cases because not the full spectrum of diagnostic methods including cytology, histology, immunohistology and PCR on cardiotropic agents, which are currently available, used in many institutions. After comprehensive clinical workup and use of imaging methods, such as echocardiography and cardiac MRI, pericardiocentesis and epicardial and pericardial biopsy were carried out under pericardioscopical control of the biopsy site. Biopsies and fluid were evaluated by cytological, histological, immunological and molecular (PCR) methods in 259 patients of our tertiary referral center following an identical clinical pathway, diagnostic and therapeutic algorithm in all cases. A standard clinical pathway and the same diagnostic and therapeutic algorithms were used in all cases. When all methods are applied to patients with pericardial effusions, “idiopathic” pericardial effusion is no longer a relevant diagnosis. Autoreactive and lymphocytic pericardial effusions are the leading diagnosis in 35 % of patients in the prospective Marburg registry, followed by malignant effusions in 28 % of cases. Viral genome was assessed in fluid and epi- as well as pericardial biopsies in 12 %, followed by post-traumatic/iatrogenic effusions in 15 % and purulent/bacterial effusions in only 2 %. Pericardioscopy permits the macroscopic inspection of the pulsating heart and its disease-associated macroscopic alterations. It also permits safe and targeted biopsy for further investigations of the tissue. Therapy, tailored to the individual etiology, can be selected such as intrapericardial instillation in autoreactive effusions with triamcinolone and with cisplatin or thiotepa in neoplastic effusions. With this approach the recurrence of pericardial effusion can be avoided effectively. A comprehensive approach to the diagnosis of pericardial effusions in conjunction with pericardioscopy for targeted tissue sampling is the prerequisite for an etiologically based intrapericardial and systemic treatment, which improves outcome and prognosis.
机译:在许多情况下,心包积液的病因学仍未解决,因为许多机构并未使用包括细胞学,组织学,免疫组织学和对心律药物的PCR在内的全部诊断方法。经过全面的临床检查并使用了超声心动图和心脏MRI等成像方法后,在心包镜检查活检部位的控制下进行了心包穿刺术和心外膜和心包活检。通过细胞学,组织学,免疫学和分子(PCR)方法对我们三级转诊中心的259例患者进行活检和体液评估,所有情况下均采用相同的临床途径,诊断和治疗算法。在所有情况下均使用标准的临床途径以及相同的诊断和治疗算法。当所有方法都适用于心包积液患者时,“特发性”心包积液不再是相关的诊断。在前瞻性Marburg登记中,自身反应性和淋巴细胞性心包积液是35%患者的主要诊断,其次是恶性积液,占28%。在液体,心外膜和心包活检中评估病毒基因组的比例为12%,其次是创伤后/医源性渗出的比例为15%,化脓/细菌性渗出的比例仅为2%。心包镜检查可以对脉动心脏及其疾病相关的宏观变化进行宏观检查。它还允许进行安全且有针对性的活检,以进一步检查组织。可以选择适合个体病因的治疗方法,例如在曲安奈德和在肿瘤性积液中用顺铂或噻替帕在自身反应性积液中进行心内滴注。用这种方法可以有效地避免心包积液的复发。心包积液的诊断与心包镜检查相结合的一种综合方法可用于靶向组织采样,这是基于病因的心包内和全身治疗的先决条件,它可以改善预后和预后。

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