Decortication of the Heart (Delorme) for Adhesive Pericarditis

Cases of adhesive pericarditis in which the patients are amenable to operative treatment may be divided somewhat arbitrarily into two groups. The commonly recognized form of the disease is that in which the mediastinal adhesions binding the pericardium to the wall of the chest dominate the picture. In other cases, however, the contraction of the thickened pericardium itself produces cardiac failure by interfering with the proper action of the heart. The recognition of the two types of the disease is of prime importance when surgical intervention is considered. It becomes obvious that no single operative procedure can be effective when the differences in the morbid anatomy are considered. The termmediastinopericarditisis properly applied to that form of the disease in which a firm cicatrix in the anterior mediastinum binds the outer aspect of the pericardium to the wall of the chest. The systolic contraction of the heart is hindered,