[HSF] Difficult pericardiectomy

[Michael Firstenberg]

Prasanna,
That is not fair - I asked you the exact same question a few months back
when I had back to back similar cases!  You were supposed to have the
answer.

Did you go on pump?  The few that I have done recently, having (and using)
that option can keep your stomach acid levels down


-michael


On 4/10/07, prasannasimha <prasannasimha at gmail.com> 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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