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[A case of constrictive pericarditis--adjuvant techniques of operation and evaluation of the perioperative cardiac
Y Ono1, S Kikuchi, S Takahashi
1Department of Cardiovascular Surgery, Aomori Prefectural Central Hospital, Japan.
Insights
This study demonstrates the successful resection of calcified constrictive pericarditis using ultrasonic surgical aspirator (CUSA) and argon beam coagulator (ABC). These techniques minimized bleeding and ensured effective hemostasis during pericardiectomy.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Technology
Background:
- Constrictive pericarditis presents with symptoms like dyspnea and fatigability.
- Significant pericardial calcification can complicate surgical intervention.
- Median sternotomy is a common approach for pericardiectomy.
Observation:
- A 43-year-old male with constrictive pericarditis and pericardial calcification underwent pericardiectomy.
- The procedure utilized an ultrasonic surgical aspirator (CUSA) and argon beam coagulator (ABC).
- Adhesions to the heart, coronary arteries, and vena cava were meticulously dissected.
Findings:
- The combined use of CUSA and ABC enabled successful resection of heavily calcified pericardium.
- Intraoperative bleeding was minimal due to precise dissection with CUSA.
- Satisfactory hemostasis was achieved using ABC, facilitating a safe surgical outcome.
Implications:
- CUSA and ABC are effective tools for managing complex pericardiectomies, especially those with extensive calcification.
- Minimally invasive dissection techniques improve surgical safety and reduce complications.
- Perioperative right ventricular ejection fraction measurements are valuable for assessing cardiac function post-surgery.
Abstract:
A 43-year-old male diagnosed as constrictive pericarditis with dyspnea, fatigability and substantial pericardial calcification on chest roentgenogram underwent pericardiectomy through median sternotomy. The heavily calcified pericardium which was adherent to the anterior and diaphragmatic surface of the heart was successfully resected by the combined use of ultrasonic surgical aspirator (CUSA) and argon beam coagulator (ABC). Intraoperative bleeding was minimal because the adhesion between the pericardium and myocardium, coronary arteries or inferior vena cava were easily dissected with CUSA. Intraoperative hemostasis was also satisfactory with ABC. Perioperative measurements of right ventricular ejection fraction were also effective in evaluating the right ventricular function.