The transdiaphragmatic approach to the heart

A modification of the transdiaphragmatic approach to the heart is described. The technique has been used successfully in both adults and children, the youngest child being 8 years of age. The approach has advantages over others in gaining access to the heart for purposes of internal cardiac massage and drainage of suppurative pericarditis and is also a suitable manaeuvre in the surgical treatment of acute tamponade. Clinical experience in the use of this approach is summarized. The transdiaphragmatic approach is recommended as a standard technique for internal cardiac massage.