Eur J Cardiothorac Surg 2000;18:728
© 2000 Elsevier Science NL
Reply to Yorganc
o
lu et al.
G.D. Angelini, Professor
Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, BS2 8HW, UK
Received 23 September 2000;
accepted 23 September 2000.
Corresponding author. Tel.: +44-117-928-3145; fax: +44-117-929-9737
e-mail: n.holloway-dee{at}bristol.ac.uk
I read with interest the report of Yorgancio
lu et al. of a case of acute ischaemia and ventricular fibrillation unresponsive to DC cardioversion due to entrapment of the vein graft in the posterior pericardectomy incision.
One possible explanation for this unusual complication is a too high posterior pericardectomy. Indeed, the graft compromised was to the intermediate which is usually in a very high position. In our experience the posterior pericardectomy is carried out with a longitiudinal incision parallel and posterior to the phrenic nerve, extending from the left inferior pulmonary vein to the diaphragm. When the incision is carried out in this position it is virtually impossible for intermediate or marginal grafts to get trapped into it unless the length of the graft has been misjudged and is too long and therefore prone to kinking. We have used the technique of posterior pericardiotomy routinely at our institution since 1994 and we have never experienced a complication like the one reported here.
