Surgical Repair of Constrictive Pericarditis in Which the Waffle Shape Cutting of the Epicardium Using an Ultrasonic Scalpel Was Effective

(Department of Cardiovascular Surgery, Tokushima Prefectural Central Hospital, Tokushima, Japan and Present address:Department of Cardiovascular Surgery, Kochi Red Cross Hospital*, Kochi, Japan)

Yoichi Ichikawa* Fumio Chikugo
A 71-year-old woman was admitted with general fatigue and appetite loss. Computed tomography showed hypertrophy of the pericardium surrounding the anterior of the right ventricule(RV). Cardiac catheterization demonstrated a rise of RV end-diastolic pressure and a dip-and-plateau pattern of the pressure curve of RV without any coronary disease. Therefore, we diagnosed heart failure due to constrictive pericarditis and performed pericardectomy using an Ultrasonic Scalpel through a median sternotomy without cardiopulmonary bypass. No improvement of the hemodynamics during the operation was found despite subtotal pericardectomy. Then, we performed the waffle shape cutting of the residual epicardium using an Ultrasonic Scalpel and obtained improvement of the hemodynamics on the operation. We then obtained increased cardiac output and the improved hemodynamics without a dip-and-plateau of the pressure curve of RV. No recurrence of the constrictive pericarditis has been found for two years. Hence, we consider that the waffle shape cutting of the epicardium using an Ultrasonic Scalpel is one of the most useful surgical repairs.
  Jpn. J. Cardiovasc. Surg. 38:126-129(2009)