[HSF] Difficult pericardiectomy

[John Schor]

Try the harmonic scalpel if you have it....we wrote this up in the  
last year or two. Search under DiLuozzo, G et al. for the ref.

John Schor, MD
PO Box 4445
Cottonwood, AZ 86326


On Apr 10, 2007, at 6:45 AM, prasannasimha wrote:

> Yesterday I did a pericardiectomy (Cause not identified preop and  
> tissue sent for HPE). It was a sheer nightmare. Thick pericardium ,  
> no good plane and I managed to do an interphrenic dissection with  
> great difficulty. The myocardium had a blotchy petechial appearance  
> even prior to cutting it (ie when you lift the pericardial edge and  
> start to cut at the plain of "cleavage") and there was  
> calcification extending into the myocardium at places and even the  
> atrial wall was calcified !! (I could not just delamellate it of  
> from certain areas and it was obvious later that it was just one  
> block of rock in those areas. The patients CVP has come down from a  
> preop of 24 to 12-13 now and he is stable but gave me some more  
> grey hairs.
> I would like to know what tips and tricks that the members use for  
> a difficult pericardiectomy. I do agree that patience and  
> cruciating segments are the common methods used. I also tend to  
> dissect following the innominate when things are really difficult  
> (In fact that helped a lot in this case) Any tips / tricks ?
> Prasanna
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