[HSF] Difficult pericardiectomy

[John Schor]

Very little bleeding, trauma to the heart, no arrhythmias, much  
easier to find the right plane.
By the way, I have gone on pump several times to do  
pericardiectomy....harmonic scalpel reduces bleeding substantially.

John Schor, MD
PO Box 4445
Cottonwood, AZ 86326


On Apr 10, 2007, at 10:41 AM, prasannasimha wrote:

> 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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