Surgical Relief of Pericardial Adhesions

Abstract

The operative procedures employed today to relieve symptoms produced by pericardial adhesions consist of (1) removing the extra pericardial adhesions extending between the pericardium and the thoracic wall (cardiolysis) and (2) extirpation of the pericardium (decortication) in those cases in which there is considerable fibrous contraction of the pericardium. It is self evident that both of these procedures are largely palliative and have been performed in patients with marked cardiac damage.

Delorme 3 advocated the division of the intrapericardial adhesions, but, because of the invariable recurrence of the adhesions, this operation was soon abandoned. Believing that the re-formation of pericardial adhesions might be prevented following their division as peritoneal adhesions by the use of digestants, 4 the following experiments were performed:

Sixty-five dogs were used. Roentgenograms and electrocardiograms in 3 positions (back, left and right) were taken before and after each operation and immediately before sacrificing the animal. Careful clinical and radiographic observations were made pre and post operatively. As a preliminary operation a pericarditis was produced by introducing irritating inorganic and organic substances into the pericardial cavity, as performed by Herrmann and Musser. 5 Pericardial adhesions, usually causing a complete synechia of the pericardial cavity, resulted in all animals.

After varying periods of time, a 2nd pericardotomy was performed, and the pericardial adhesions were divided. In one series a vegetable digestant of the papain group was introduced into the pericardial cavity, following the division of the adhesions, in order to prevent their re-formation. In one control series physiological saline solution, and in another 2nd control series nothing, was introduced into the pericardial cavity.

Of the 65 animals many were lost early in the series, because of faulty technic. Many died as a result of barbital anesthesia. In the control animals in which, following the division of the pericardial adhesions, either nothing or physiological saline solution was added to the pericardial cavity, adhesions invariably re-formed.