Surgical Technique for the Management of Constrictive Epicarditis Complicating Constrictive Pericarditis (The Waffle Procedure)

Constrictive pericarditis after lung transplantation: An under-recognized complication

“…In these patients, the Waffle procedure can be performed, such an approach being necessary in our second and third patients. 3 Only Billings et al 2 have confirmed CP in a lung transplant patient; however, they relate the patient having an underlying diagnosis of LAM as the potential cause of CP. At the Toronto Lung Transplant Program, we have performed transplants in 13 LAM patients since 1989, and CP developed in only 1 patient.…”

“…During the redo surgery, there was dense epicardial fibrosis and only relaxing incisions could be performed. 3 His hemodynamic parameters improved, with the RAP dropping to 8 mm Hg after the redo operation. He remained well from the cardiac perspective; however, chronic lung allograft rejection developed, and he died in March 1996.…”

The waffle procedure as treatment of a first episode of right heart failure: a case report

“…Regarding the surgery, pericardiectomy is an effective treatment. However, it is known that in constrictive pericarditis the constriction depends mainly on the visceral layer of the pericardium so a radical pericardiectomy alone could not be effective in patients with a marked epicardial constriction as described by Heimbecker et al 3 , 4 , 6 , 15 . The waffle procedure consists of removing longitudinal and transverse epicardial tissue strips of the visceral layer.…”

Constrictive Pericarditis Post-Lung Transplant

“…A possible intraoperative difficulty that can be encountered is dense myocardial fibrosis or calcification making the separation of the parietal pericardium from the cardiac epicardium difficult or even impossible. In these patients, the Waffle procedure can be performed in which the underlying constricting epicardium is incised by intersecting longitudinal and transverse incisions to make islands of scar tissue.…”