This is how I do it. Polyglycolic acid mesh pericardial closure after intrapericardial pneumonectomy
✍ Scribed by Dr. John D. Urschel
- Publisher
- John Wiley and Sons
- Year
- 1993
- Tongue
- English
- Weight
- 69 KB
- Volume
- 52
- Category
- Article
- ISSN
- 0022-4790
No coin nor oath required. For personal study only.
✦ Synopsis
Cardiac herniation is a rare but catastrophic complication of intrapericardial pneumonectomy [ 11. Cardiac herniation through a pericardial defect results in pronounced cardiac embarrassment. Immediate reoperation and cardiac reduction is required. Preventative strategies include pericardial closure for all right-sided defects and either pericardial closure or wide pericardiectomy for left pericardial defects .
A number of autologous and synthetic materials have been used for pericardial patch closure . Autologous materials such as fascia lata are time-consuming to harvest and local pleural flaps may lack sufficient strength to resist cardiac herniation. Synthetic materials, such as Dacron and polytetrafluoroethylene patches, are commonly employed. If postpneumonectomy empyema occurs, a synthetic pericardial patch will usually require removal.
Pericardial closure with absorbable polyglycolic acid mesh (Dexon mesh, Davis and Geck, Wayne, NJ) would appear to be the method of choice for prevention of postoperative cardiac herniation. Polyglycolic acid maintains its strength for approximately 4 weeks and is completely absorbed after 4 months [3]. Since most cardiac herniations occur within 24 hours of operation [ l], permanent materials are not required for pericardial closure. In the event of postpneumonectomy empyema, spontaneous absorption of polyglycolic mesh is an advantage over previously described prosthetic patches. Polyglycolic acid mesh closure is recommended for postpneumonectomy pericardial defects.