Radical pericardiectomy via left anterolateral thoracotomy (UKC's modification): a video presentation

Abstract

In order to decrease the perioperative mortality rates of 7.6% in our series and 6-19% in several large series published after 1985 and postoperative low cardiac output syndrome between 24-28% following total pericardiectomy, the author proceeded to perform several technical modifications as enunciated in the video to achieve further radical excision of the pericardium posterior to the phrenic nerve and diaphragmatic pericardium [1-3]. For uniformity with other studies, total pericardiectomy was defined as wide excision of the pericardium with the phrenic nerves defining the posterior extent, the great vessels including the intrapericardial portion of superior vena cava and superior vena cava-right atrial junction defining the superior extent, and the diaphragmatic surface, including the inferior vena cava-right atrial junction defining the inferior extent of the pericardial resection. Radical pericardiectomy was defined as excision of the pericardium as defined under total pericardiectomy including the removal of the pericardium posterior to the phrenic nerve and the diaphragmatic pericardium. Constricting layers of the epicardium were removed whenever possible. The atria and venae cavae were decorticated as a routine [1-3]. We report herein the surgical details of radical pericardiectomy performed without utilizing cardiopulmonary bypass via modified left anterolateral thoracotomy as developed by the corresponding author. A 42-year-old lady diagnosed with calcific chronic constrictive pericarditis in New York Heart Association Class IV underwent radical pericardiectomy via modified left anterolateral thoracotomy. The postoperative recovery was uneventful. We conclude that using several technical modifications of pericardial excision, it is possible to achieve radical pericardiectomy via modified left anterolateral thoracotomy, particularly removing the constricting pericardium over the anterolateral, diaphragmatic surfaces of left ventricle, anterior and diaphragmatic surfaces of right ventricle until the right atrioventricular groove without utilizing cardiopulmonary bypass.