Circular pericardial drainageの癒着防止効果

Adhesion Prevention Effect of Circular Pericardial Drainage

心臓再手術の一番の問題点は癒着である．心臓の周囲が癒着していると，癒着剝離に多大な労力を要する．心大血管の損傷や冠状動脈バイパスグラフトの損傷は重大な合併症となる1）．癒着軽減のため，ePTFEシートやフィルム製剤の貼付が考案されているが2～4），右室前面の効果のみで左室側には効果がない．われわれは，これまで効率的な術後心囊内ドレナージ法としてcircular pericardial drainage（CPD）を2007年に考案し，その術式を報告している5）．CPD導入後癒着防止効果があったと思われた3例を経験したので，手術所見を報告する．

Pericardial adhesions can pose serious problems during cardiac reoperation. Here, we report three cases where circular pericardial drainage （CPD） was performed during the initial surgery and no pericardial adhesions were found during reoperation. All three patients had initially undergone an aortic valve replacement with CPD.

Case 1：An 80-year-old female was reoperated this time for an aneurysm of the ascending aorta. A replacement of the ascending aorta was performed.

Case 2：A 76-year-old male underwent a second aortic valve repair indicated for prosthetic valve infection.

Case 3：The patient was an 82-year-old female. This time, mitral valve replacement, indicated for severe mitral valve stenosis, was performed.

In these three cases, there were almost no adhesions in the CPD route. The diaphragmatic pericardial surface, the oblique sinus of pericardium, and the lateral side of the left ventricle were also adhesion-free. CPD can effectively drain postoperative pericardial hemorrhage and thus prevent pericardial adhesions.