[HSF] Difficult pericardiectomy

[prasannasimha]

I am curious - in what way does the Harmonic scalpel ease dissection in 
these cases apart from decreasing the risk of fibrillation with a 
conventional cautery (though I do tend to use scissors more  often than 
cautery  during a pericardiectomy)
Prasanna

John Schor wrote:
> 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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