Affiliations: Wayne State University School of Medicine Detroit, MI,
Harvard Medical School Boston, MA
Correspondence to: Frank A. Baciewicz, Jr, MD, FCCP, Associate Professor, Cardiothoracic Surgery, Wayne State University School of Medicine, 3990 John Rd, Detroit, MI 48201
To the Editor:
I read with interest the article by Byrne et al in the December 2002 issue.1
I have two questions regarding management of this difficult patient cohort.
First, in the cases in which the parietal pericardium was excised on the left side, was Gortex (WL Gore; Sunnyvale, CA) or other material used to close the pericardium? Might replacing the pericardium, which is usually not recommended, prevent this complication or at least lengthen the interval until it occurred?
Second, it appeared that the patients who had positive histology results or histology demonstrating tumor recurrence on reoperation had a much poorer survival rate. If there was tumor present on the frozen section, should the cardiac decortication be aborted?
The use of a Gortex (WL Gore; Sunnyvale, CA) membrane to reconstruct the parietal pericardium after right extrapleural pneumonectomy (EPP) is routine, so as to avoid cardiac herniation. However, as Dr. Baciewicz rightly states, it is rarely used after left EPP. Dr. Baciewicz’s suggestion to use Gortex after left EPP to attempt to prevent this complication, or to at least delay its onset, seems like a reasonable idea. Although we have anecdotal experience with this approach, we have not observed any meaningful difference in outcome.
With regard to tumor recurrence, since the palliative operation is principally performed to relieve symptoms of shortness of breath and fluid overload, we have not attempted to determine whether or not the fibrous scar overlying the myocardium is tumor, as this finding would not change our plans to at least attempt decortication.
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