Waffle Procedure for a Cool Constrictive Epicarditis

iThe First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japanj

Kazuhiro Ohkura Katsushi Yamashita Hitoshi Terada
Naoki Washiyama Satoshi Akuzawa
We describe the case of a 59-year-old man who developed constrictive epicarditis 2 months after an episode of acute pericarditis. Magnetic resonance imaging demonstrated parietal pericarditis and epicarditis. Through a median sternotomy, a markedly thickened parietal epicardium was noted which was removed where possible. After this procedure, however, no improvement of the hemodynamic parameters was observed. We attempted removal of the epicardium, but the procedure had to be abandoned due to myocardial injuries and bleeding. Multiple longitudinal and transverse incisions were carefully performed on the thickened epicardium, following which relief of constriction along with a remarkable improvement of the hemodynamic status was achived. Although the dip and plateau pattern was persisted, cardiac index increased from 2.2 to 2.9l/min/m2 and the pulmonary capillary wedge pressure decreased from 20 to 13mmHg. Patientfs postoperative course was uneventful and he was discharged on postoperative day 22.
  Jpn. J. Cardiovasc. Surg. 38:138-141i2009j