Culliford A T, Lipton M, Spencer F C
Ann Thorac Surg. 1980 Feb;29(2):146-52. doi: 10.1016/s0003-4975(10)61653-0.
Our experience with 27 patients undergoing pericardiectomy at New York University Medical Center over the past 13 years has evolved a radical pericardiectomy operation suggesting that two traditional concepts are erroneous: (1) pericardiectomy limited to the anterior and lateral surfaces of the ventricles is an adequate operation and (2) delayed recovery is due to myocardial "atrophy" and not to inadequate operation. Radical pericardiectomy entails removal of virtually the entire parietal pericardium from all cardiac surfaces including that of both ventricles, the right atrium, and the venae cavae. Performed in 22 patients by dissecting a cleavage plane between the thickened parietal pericardium and underlying epicardium, all procedures were done through a sternotomy. Intraoperative monitoring of arterial pressure, cardiac output, and wedge pressure is essential because of displacement of the left ventricle. The left ventricle can be completely mobilized so that at the end of the operation the entire heart can be lifted upward and the course of the coronary sinus fully visualized. Intraoperative pressure measurements demonstrate that this radical resection immediately corrects hemodynamic abnormalities (elevated right atrial and ventricular end-diastolic pressures), as demonstrated in 10 patients. Most patients undergo massive diuresis (7 to 16 kg) within two weeks, with an uneventful recovery. These findings contrast markedly with early experiences using a conventional limited pericardiectomy.
在过去13年里，我们在纽约大学医学中心为27例患者实施了心包切除术，由此逐渐形成了一种根治性心包切除术，这表明两个传统观念是错误的：（1）局限于心室前表面和侧面的心包切除术是一种充分的手术；（2）恢复延迟是由于心肌“萎缩”而非手术不充分。根治性心包切除术需要从包括两个心室、右心房和腔静脉在内的所有心脏表面切除几乎整个壁层心包。通过在增厚的壁层心包和下层心外膜之间解剖出一个分离平面，对22例患者进行了手术，所有手术均通过胸骨切开术完成。由于左心室移位，术中监测动脉压、心输出量和楔压至关重要。左心室可以完全游离，这样在手术结束时整个心脏可以向上提起，冠状窦的走行可以完全看清。术中压力测量表明，这种根治性切除术能立即纠正血流动力学异常（右心房和心室舒张末期压力升高），10例患者的情况证明了这一点。大多数患者在两周内出现大量利尿（体重减轻7至16千克），恢复顺利。这些发现与早期使用传统有限心包切除术的经验形成了明显对比。
