PERICARDECTOMY (grech, peri around, near + kardia heart + ectome removal) — operation of removal of a pericardiac cover.
The main indication — chronic squeezing pericardis (see).
Distinguish partial P. (Wren's operation — Delorma, a cardiolysis, or a pericardiolysis) — partial excision pericardium (see) with a section or division of cordial and pericardiac unions (see. Pericardis ) and suototalny P. at which excise almost all pericardium. Partial P. is used seldom, most often apply subtotal
P. V the preoperative period usually hold the events reducing degree of cardiovascular insufficiency: diet, heart and vascular drugs, diuretics, etc.
Anesthesia — an endotracheal anesthesia (see. Inhalation anesthesia ). Accesses to a pericardium — longitudinal chrezgrudinny or chrez-two-pleural with cross crossing of a breast (see. Mediastinotomy ). In the beginning do small (1,5 — 2 cm) a section of a pericardium (pericardiotomy) in the field of a left ventricle to bare an epicardium, then it is necessary to find a layer between a pericardium and an epicardium. As soon as this layer is revealed, edges of a pericardium take the tool and, carefully moving apart them, begin flaking of a pericardium from an epicardium. If the calcinated sites which are deeply getting into a myocardium them carefully meet bypass around and leave in the form of islands. Extra care is observed at excision of a pericardium in the field of coronal vessels, at release of auricles and venas cava because of a subtlety of their walls. Beginning gradual flaking of a pericardium with a left ventricle, further strictly adhere to such sequence of release of heart: left auricle, mouths of a pulmonary trunk and aorta, right ventricle, right auricle and openings of venas cava. Such priority is dictated by danger of an overload of the right departments of heart with the subsequent edematization of lungs. After P.'s end the operational wound is layer-by-layer sewn up.
Postoperative complications in the early period: strengthening of cardiovascular insufficiency, bleeding in a pleural cavity; in late — suppuration of a wound, purulent mediastinitis (see).
In the postoperative period appoint anesthetics and cardiacs, antibiotics; at a tubercular etiology of a pericardis — specific treatment. Parenteral administration of proteinaceous drugs, especially plasmas is of great importance.
The lethality at subtotal P. makes 5 — 8%.
The data obtained during the studying of the long-term results of P. show that at most of the operated patients working capacity completely is recovered.
Bibliography: Bakulev A. N. Surgical treatment of an adhesive pericarditis, in book: Vopr, grudn. hir., under the editorship of B. E. Linberg, t. 4, page 239, M., 1952; Dzhanelidze Yu. Yu. Collected works, t. 4, page 510, M., 1953; Kolesnikov I. S., P at t about in N. V. and of p e e of N-N and to about in and A. T. Chronic perikardita, M., 1964; The Multivolume guide to surgery, under the editorship of B. V. Petrovsky, t. 6, book 1, page 495, M., 1965; Petrovsky B. V. Hirurgiya of a mediastinum, M., I960-; Gibbon J. H. Jibbon’s surgery of the chest, p. 974, Philadelphia, a. o., 1976.
P. P. Zubarev.