| The Waffle Procedure for Postoperative
Constrictive Epicarditis after Expanded Polytetrafluoroethylene
Surgical Membrane as a Pericardial Substitute |
(Department of Thoracic and Cardiovascular Surgery,
Hyogo College of Medicine, Nishinomiya, Japan)
| Hideki Yao |
Takashi Miyamoto |
Katsuhiko Yamashita |
| Sukemasa Mukai |
Torazou Wada |
Mitsuhiro Yamamura |
| Takashi Nakagawa |
Masaaki Ryomoto |
|
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Several substitutes have been utilized
for pericardial closure after open heart surgery. A 55-year-old
man was admitted to our hospital with a diagnosis of constrictive
pericarditis 13 years after open mitral commissurotomy. At reoperation,
the thickened pericardium was peeled off and the epicardium was
covered with 0.1mm expanded polytetrafluoroethylene surgical
membrane (Gore-tex®, sheet thickness 0.1mm). At the 7th postoperative
day, he complained of fatigue and dyspnea. Physical examination
revealed jugular venous distension, hepatomegaly, ascites and
peripheral edema. Cardiac catheterization suggested the suspicion
of pericardial or epicardial constriction. On the 3rd-operation,
the Gore-tex® sheet was removed and multiple longitudinal and
transverse incisions were made in the thickened epicardium, that
is the waffle procedure, while protecting the myocardium and
the coronary arteries. Perioperative hemodynamics improved remarkably.
His cardiac index increased from 3.0 to 4.5l/min/m2. The postoperative
course was uneventful.
@Jpn. J. Cardiovasc. Surg. 30F134-136 (2001) |
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