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

Abstract

BackgroundConstrictive pericarditis is a rare condition which is characterized by pericardial layers thickening and it may not be relieved by conventional medical or surgical therapies. Some patients could profit from specific surgical techniques such as the waffle procedure which removes epicardial tissue strips of the visceral layer of the pericardium. It alleviates diastolic dysfunction, since it is known that the constrictive physiology observed in constrictive pericarditis depends mainly on the visceral layer.Case summaryWe describe the case of a 59-year-old male complaining of predominantly right heart failure symptoms. Initially, a transthoracic echocardiogram showed pericardial effusion with several fibrous tracts and a constrictive pattern. The work-up was completed with thoracic computed tomography and right heart catheterization along with several microbiological, serological and immunological tests. The final diagnosis was idiopathic constrictive pericarditis. The clinical course was unfavourable, and the patient was referred for prompt surgical treatment using a technique called the waffle procedure. Subsequently, the patient has remained asymptomatic.DiscussionConstrictive pericarditis combines features of both constriction and tamponade. Some patients may present an unfavourable clinical course with conventional therapeutic approaches. They could benefit from the waffle procedure which allows an improvement in diastolic and, subsequently, in systolic function.

Case report: Treatment of constrictive epicarditis using the waffle procedure in a dog that had previously undergone a subtotal pericardiectomy

“…The cause of CP is often unknown, but when identified in animals, it can be caused by metallic foreign bodies, infectious agents such as actinomycosis and coccidioidomycosis, chronic conditions such as chylothorax or idiopathic pericardial effusion and neoplasms such as lymphoma, mesothelioma or carcinomatosis of the pericardium (2,8,14). In humans, the most common causes are idiopathic (61%) and following cardiac surgery (37%) (15).…”

“…In a small subset of human patients with constrictive pericarditis, the epicardium is also thickened, resulting in constrictive epicarditis. These affected patients do not improve postoperatively, requiring a repeat surgery called the waffle procedure (5,15).…”

A Rare Case of Effusive-Constrictive Pericarditis Caused by Streptococcus agalactiae: Emergency Surgical Treatment

“…In the modern antibiotic era, the S. agalactiae infection [2][3][4] of the endocardium and pericardial space is an extremely rare occurrence (Table 1). Predisposing factors for an S. agalactiae infection are related to immunosuppressive conditions, such as alcoholism, diabetes mellitus, liver cirrhosis, intravenous drug abuse, neoplasms, and HIV infections.…”

„Turtle cage” módszer a pericarditis constrictiva szívsebészeti kezelésében – rövid távú eredményeink

“…A perioperatív mortalitás és morbiditás csökkentésére a pericardiectomia megfelelő alternatívájának tűnt a korábban az irodalomban kis esetszámban leírt, úgynevezett "turtle cage ", vagy más néven "waffle" beavatkozás, melyet kifejezetten a pericardium viscerale meszesedésének és megvastagodásának, az úgynevezett epicarditis constrictivának a kezelésére dolgoztak ki [10][11][12]. A módszert részletesen ismertetjük a Módszerek fejezetben.…”