Key result
Waffle shape epicardial cutting with an ultrasonic scalpel improves hemodynamics in a constrictive pericarditis patient.
Case Report (n=1)
No
Waffle-shape cutting of the epicardium using an ultrasonic scalpel may be an effective and safe surgical technique for improving hemodynamics in patients with constrictive pericarditis.
May aid select constrictive pericarditis cases via epicardial waffle incision; leaves open need for controlled validation before broader use.
症例は71歳，女性．全身倦怠感や食欲不振が出現し，精査・加療目的に当院に紹介となった．UCGにて心膜肥厚と右室拡張障害を認め，心臓カテーテル検査で右室拡張末期圧の上昇とdip-and-plateau波形を認めたため，収縮性心膜炎と診断し胸骨正中切開にて手術を施行した．心拍動下にUltrasonic Scalpelを用い心膜切除術を施行したが，循環動態の改善が得られず，残存した心外膜肥厚に対してUltrasonic Scalpelを用いてワッフル状切開を行った．その後より，dip-and-plateau波形は消失し，著明な心拍出量の増加を認め，循環動態の改善が得られた．収縮性心膜炎の心膜剥離・切除の際にはUltrasonic Scalpelが非常に有用であり，さらに残存した心外膜をワッフル状に切開することによりに安全かつ容易に循環動態の改善を得ることができ，有効な手術手技の一つと考えられた．
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Ichikawa et al. (2009) conducted a case report in Constrictive pericarditis (n=1). Waffle shape cutting of the epicardium using an Ultrasonic Scalpel was evaluated on Hemodynamic improvement (disappearance of dip-and-plateau pattern and increased cardiac output). Waffle shape cutting of the residual epicardium using an Ultrasonic Scalpel successfully improved hemodynamics and increased cardiac output in a patient with constrictive pericarditis.
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