[The waffle procedure (multiple incision of epicardium) with pericardiectomy for constrictive pericarditis].

H Tsukui, K Ohara, T Akimoto, M Mukaida, K Abe
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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.

[缩窄性心包炎的华夫勒手术(心外膜多切口)心包膜切除术]。
心包切除术是治疗缩窄性心包炎唯一有效的手术方法,但我们经常发现血流动力学参数缺乏显著改善,这是由于存在残留的缩窄。我们有两例缩窄性心包炎患者。在这些患者中,我们在没有体外循环的情况下,照例在双侧膈神经前方对心包进行去皮,然后在纤维性心外膜上仔细地做了多个纵向和横向切口,避免了预测的冠状动脉主要分支和心肌的走向。手术结束时,心外膜纤维表面呈华夫饼状。通过这种操作,收缩得到缓解,心肌能够重新扩张,从而获得充分的血流动力学反应。2例患者完全康复,于术后第18、19天出院。他们目前没有临床症状。
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