pericardectomy

Cardiac resection should be performed as soon as possible after the diagnosis of constrictive pericarditis. Even if there is partial empyema and effusion in the pericardial cavity, the fibrous plate is not completely formed. As long as the narrowing has hindered the function of the heart, the early surgery to relieve the compression is delayed. It is better to have surgery after the fiberboard is completely formed. Treating diseases: constrictive pericarditis Indication Cardiac resection should be performed as soon as possible after the diagnosis of constrictive pericarditis. Even if there is partial empyema and effusion in the pericardial cavity, the fibrous plate is not completely formed. As long as the narrowing has hindered the function of the heart, the early surgery to relieve the compression is delayed. It is better to have surgery after the fiberboard is completely formed. Preoperative preparation 1. Correct anemia and malnutrition. 2. Correct cardiac dysfunction caused by atrial fibrillation or heart failure. Digitalis drugs can be used in combination with diuretics; however, it should be noted that such patients are prone to digitalis poisoning before the heart is compressed. Digitalis and diuretics should be discontinued 24 hours before surgery. If the condition is serious, the drug can be stopped. 3. Anti-tuberculosis treatment: Unless it is clearly caused by non-tuberculosis, anti-tuberculosis treatment should be routinely used. If there are symptoms of tuberculosis, anti-tuberculosis treatment should reach stable condition, tuberculosis symptoms disappear, and erythrocyte sedimentation rate can be treated surgically. 4. Ascites significantly affects the respiratory cycle, 48 hours before surgery should be appropriate ascites decompression, to relieve breathing restriction. 5. Stop the salt diet for a few days before surgery and change to an ordinary diet to adjust the electrolyte balance. Surgical procedure 1. Position: supine position, the patient can temporarily take the reclining position when the patient can not tolerate, and change to the supine position after anesthesia. 2. Incision: The median incision of the sternum. 3. Stripping the pericardium: Two traction lines are made on the anterior side of the left ventricle. The thickened pericardium is cut into the ten-shaped line between the traction lines and reaches the myocardium. At this time, the myocardium is bulged from the incision. Traction thickened pericardium, sharply cut the adhesion between the happy bag and the heart with scissors, loose adhesion can be blunt peeling, but need to prevent myocardial tear. Peeling should start from the left ventricle, then the right ventricular outflow tract is removed, and finally the entire right ventricle is extended, and the phrenic nerve should be stripped on both sides. The face should be peeled off as much as possible so that the heart can leave the pericardium on its back side. At this point, diastole and contraction can be completely unrestricted. In the event of myocardial injury bleeding when the pericardium is removed, it can be covered with a pericardial piece that has not been removed and removed, and sutured to stop bleeding [Fig. 1-1-6]. 4. Excision of the pericardium: After completing the complete dissection plan, the excised pericardial piece can be removed one by one, and the pericardium is removed, and the blood is stopped by electrocautery, so as to stop bleeding completely. 5. Place the drainage tube: After rinsing, draw a soft rubber tube with a multi-side hole in the anterior mediastinum, and draw it from the lower end of the incision so that the lowest one side hole is located at the lowest position of the mediastinum. 6. Close the chest.

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