Waffle Procedure for a Constrictive Pericarditis as an Emerging Manifestation of Hyper-IgG4 Disease

(Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara, Japan)

Keigo Yamashita Takehisa Abe Nobuoki Tabayashi
Yoshiro Yoshikawa Yoshihiro Hayata Tomoaki Hirose
Shun Hiraga Yoichi Kameda Yinghao Hu
Shigeki Taniguchi
A 74-year-old man presenting with general fatigue and dyspnea was admitted to another hospital. He was transferred to our hospital because his symptoms deteriorated and pericardial fluid increased. The symptoms did not improve even after percutaneous pericardial drainage. On a diagnosis of heart failure due to pericardial constriction, he underwent pericardiectomy. No hemodynamics improvement was found despite subtotal pericardiectomy. Multiple longitudinal and transverse incisions like a waffle were made in the thickened epicardium and improved the hemodynamics. The symptoms improved after sugery. Steroid therapy was effective after pathological examination of the excised epicardium that confirmed an emerging manifestation of hyper-IgG4 disease. We report a waffle procedure with good results for a constrictive pericarditis with hyper-IgG4 disease.
  Jpn. J. Cardiovasc. Surg. 41:95-98(2012)

Keywords:constrictive pericarditis, waffle procedure, hyper-IgG4 disease