Off-pump subtotal pericardiectomy using ultrasonic aspirator in constrictive pericarditis.
Ishita Srivastava, Murat Yildiz, Martha Veit et al.
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Case in brief
A patient with constrictive pericarditis underwent subtotal pericardiectomy without cardiopulmonary bypass because of advanced age and underlying liver cirrhosis. The pericardium was massively calcified, with involvement extending to the aortic base and diaphragm, and was densely adherent to the epicardium. Resection over the right atrium, right ventricle and anterior left ventricular wall used an ultrasonic aspirator alongside a rongeur and electrocautery, with the phrenic nerves and underlying structures carefully preserved. Complete removal was not possible because of adhesions and nearby critical structures. Intraoperative echocardiography showed immediate improvement in cardiac filling and function.
What made this case unusual
The ultrasonic aspirator was used to remove extensively calcified pericardium while carefully separating it from the epicardium and preserving underlying myocardium and epicardial vessels.
Diagnostic / clinical pearl
In heavily calcified, adherent constrictive pericardium, controlled, stepwise resection can help limit injury to underlying cardiac structures; complete pericardiectomy may not be achievable when adhesions and critical anatomy make further dissection unsafe.