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[The waffle procedure (multiple incision of epicardium) with pericardiectomy for constrictive pericarditis]
1Department of Cardiovascular Surgery, St. Luke's International Hospital, Tokyo, Japan.
Insights
This study introduces a novel pericardiectomy technique for constrictive pericarditis. The waffle-like epicardial scoring improved hemodynamic function and patient recovery.
Area of Science:
- Cardiology
- Thoracic Surgery
Background:
- Constrictive pericarditis requires pericardiectomy, but residual constriction often limits hemodynamic improvement.
- Current pericardiectomy techniques may not fully relieve myocardial restriction.
Observation:
- Two patients with constrictive pericarditis underwent a modified pericardiectomy.
- The procedure involved decortication and epicardial scoring without cardiopulmonary bypass.
Findings:
- A 'waffle-like' epicardial pattern was created through multiple incisions.
- This technique successfully relieved constriction, allowing myocardial reexpansion and adequate hemodynamic response.
Implications:
- This modified pericardiectomy offers a promising approach to improve outcomes in constrictive pericarditis.
- The technique facilitated full recovery and symptom resolution in the treated patients.
Abstract:
Pericardiectomy is the only effective surgical procedure for constrictive pericarditis, but we have often experienced a lack of significant improvement of hemodynamic parameters, this being attributed to the presence of residual constriction. We have had two patients with constrictive pericarditis. In these patients, we decorticated the pericardium as usual, anterior to the bilateral phrenic nerves without cardiopulmonary bypass, and then, multiple longitudinal and transverse incisions were carefully made in the fibrous epicardium, avoiding the predicted course of major coronary branches and the myocardium. At the end of the procedure, the epicardial fibrous surface acquired a waffle-like appearance. With this maneuver, relief of constriction was achieved and the myocardium was able to reexpand, thus obtaining an adequate hemodynamic response. Our two patients recovered fully, and were discharged on the 18th and 19th postoperative day. They are presently free of clinical symptoms.