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Article in Japanese | WPRIM | ID: wpr-738313


We present the case of a 72-year-old man with constrictive pericarditis due to tuberculous pericarditis, who was treated with the waffle procedure via left anterolateral thoracotomy. The preoperative catheterization study showed the dip-and-plateau pattern, and the echocardiographic study shown the thickened pericardium and dilatation impairment. The surgery was able to be performed without cardiopulmonary bypass. The thickened pericardium was abraded with a Harmonic Scalpel. The waffle procedure was effective in this patient. The postoperative course was good, with improvement of NYHA status and cardiac pressure study results. We suggest that this procedure is useful for the patients with constrictive pericarditis.

Article in Japanese | WPRIM | ID: wpr-363069


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.

Article in Japanese | WPRIM | ID: wpr-362116


A 62-year-old woman who had suffered from malignant articular rheumatism since 2000 felt fatigue, exertional dyspnea and edema was admitted in May 2009. Cardiac catheterization demonstrated a dip-and-plateau pattern of the pressure curve of RV. Therefore we diagnosed constrictive pericarditis. She decided to have surgery as soon as possible. As she had also been troubled with constrictive pulmonary damage, chronic renal failure, and was taking an inotropic agent, we concluded that the use of extracorporeal circulation was risky. After median sternotomy, we recognized diastolic insufficiency of the heart due to hypertrophy of the epicardium. Using an ultrasonic scalpel and electrotome, we incised the thickened epicardium with a waffle procedure. The dip-and-plateau disappeared and as a result the cardiac index was improved immediately (1.9 <i>l</i>/min/m<sup>2</sup>→2.6 <i>l</i>/min/m<sup>2</sup>). She was discharged on postoperative day 25. In this way waffle procedure for constrictive pericarditis can an effective surgical procedure for a high risk patient.

Article in Japanese | WPRIM | ID: wpr-361904


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 2.9 <i>l</i>/min/m<sup>2</sup> and the pulmonary capillary wedge pressure decreased from 20 to 13 mmHg. Patient's postoperative course was uneventful and he was discharged on postoperative day 22.