Advanced effusive-constrictive pericarditis rescued by the aggressive waffle procedure.
Kazuhiro Yamazaki1, Akira Marui, Takahiro Nakahara
1Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-machi, Sakyo, Kyoto, 606-8507, Japan. yamakazu@kuhp.kyoto-u.ac.jp
General Thoracic and Cardiovascular Surgery
|March 29, 2012
Summary
A 68-year-old man experienced worsening heart failure from effusive-constrictive pericarditis. Aggressive pericardiectomy, a "waffle procedure," successfully treated his condition.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Effusive-constrictive pericarditis is a rare condition characterized by inflammation and fluid accumulation around the heart, leading to impaired cardiac function.
- Progressive heart failure can result from the compression of heart chambers by inflamed pericardium and effusion.
Observation:
- A 68-year-old male presented with rapidly worsening heart failure over one month.
- Echocardiography showed progression from pericarditis with effusion to pericardial thickening and diastolic dysfunction.
- Cardiac catheterization indicated persistent high right heart pressures even after pericardiocentesis.
Findings:
- The patient underwent an aggressive pericardiectomy with sharp epicardial dissection, a technique known as the 'waffle procedure'.
- This on-pump beating-heart surgery effectively relieved the constrictive physiology.
- Post-operative recovery was successful, resolving the heart failure symptoms.
Implications:
- The 'waffle procedure' represents a viable surgical option for managing advanced effusive-constrictive pericarditis.
- Early recognition and aggressive surgical intervention are crucial for improving outcomes in such cases.
- This case highlights the importance of surgical expertise in treating complex pericardial diseases.
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