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
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)