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Gen Thorac Cardiovasc Surg. 2012 May;60(5):297-301. doi: 10.1007/s11748-011-0798-9. Epub 2012 Mar 28.

Advanced effusive-constrictive pericarditis rescued by the aggressive waffle procedure.

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Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-machi, Sakyo, Kyoto, 606-8507, Japan.


We report the case of a 68-year-old man with progressive heart failure due to effusive-constrictive pericarditis. During approximately 1 month, echocardiography revealed rapid progression from pericarditis with effusion without tamponade to pericardial thickening and diastolic dysfunction. Cardiac catheterization revealed that the pressure in the right heart chambers remained high after pericardiocentesis. The patient was rescued by aggressive pericardiectomy and sharp dissection of the epicardium into small fragments. This on-pump beating-heart surgery is known as the waffle procedure.

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