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Clarifying Cardiac Decortication Procedure

Wayne State University School of Medicine Detroit, MI

Correspondence to: Frank A. Baciewicz, Jr, MD, FCCP, Associate Professor, Cardiothoracic Surgery, Wayne State University School of Medicine, 3990 John Rd, Detroit, MI 48201

To the Editor:

I read with interest the article by Byrne et al in the December 2002 issue.¹ I have two questions regarding management of this difficult patient cohort.

First, in the cases in which the parietal pericardium was excised on the left side, was Gortex (WL Gore; Sunnyvale, CA) or other material used to close the pericardium? Might replacing the pericardium, which is usually not recommended, prevent this complication or at least lengthen the interval until it occurred?

Second, it appeared that the patients who had positive histology results or histology demonstrating tumor recurrence on reoperation had a much poorer survival rate. If there was tumor present on the frozen section, should the cardiac decortication be aborted?

References

1. Byrne, JG, Karavas, A, Colson, Y, et al (2002) Cardiac decortication (epicardiectomy) for occult constrictive cardiac physiology after left extrapleural pneumonectomy. Chest 122,2256-2259[Abstract/Free Full Text]

Harvard Medical School Boston, MA

Correspondence to: John G. Byrne, MD, FCCP, Brigham & Women’s Hospital, 75 Francis St, Boston, MA 02115; e-mail: jbyrne{at}partners.org

To the Editor:

The use of a Gortex (WL Gore; Sunnyvale, CA) membrane to reconstruct the parietal pericardium after right extrapleural pneumonectomy (EPP) is routine, so as to avoid cardiac herniation. However, as Dr. Baciewicz rightly states, it is rarely used after left EPP. Dr. Baciewicz’s suggestion to use Gortex after left EPP to attempt to prevent this complication, or to at least delay its onset, seems like a reasonable idea. Although we have anecdotal experience with this approach, we have not observed any meaningful difference in outcome.

With regard to tumor recurrence, since the palliative operation is principally performed to relieve symptoms of shortness of breath and fluid overload, we have not attempted to determine whether or not the fibrous scar overlying the myocardium is tumor, as this finding would not change our plans to at least attempt decortication.

This Article Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Baciewicz, F. A. Articles by Sugarbaker, D. J. Search for Related Content PubMed PubMed Citation Articles by Baciewicz, F. A., Jr Articles by Sugarbaker, D. J.