Pericardiectomy for post-coronary artery bypass grafting constrictive pericarditis; strategy for safe and complete pericardiectomy

Surgery for constrictive pericarditis after coronary artery bypass grafting (CABG) needs complete pericardiectomy without injury to bypass grafts. We performed pericardiectomy for post-CABG constrictive pericarditis 15 months after the first surgery. Preoperative multislice helical 3-dimensional computed tomography (CT) clearly demonstrated the patent bypass grafts and anatomical relationship between grafts and surrounding organs. Among surgical approaches, we chose bilateral thoracotomy to avoid injury to the bypass grafts and to obtain a good surgical exposure, especially for pericardiectomy of the left side of the heart. Additionally, with the use of intraoperative doppler ultrasound blood flowmetry, we could safely achieve complete pericardiectomy. We conclude that the combined application of 3-dimensional CT, bilateral thoracotomy and doppler ultrasound blood flowmetry was a supreme strategy for the operation of constrictive pericarditis after CABG.