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J Thorac Cardiovasc Surg 2003;125:1177
© 2003 The American Association for Thoracic Surgery

Letters to the Editor

Reply

Alessandro Baisi, MD, Luigi Santambrogio, MD, Ugo Cioffi, MD

Department of Surgery, University of Milan, Milan, Italy

Reply to the Editor:

Thank you for the opportunity to comment on Weissberg's letter concerning our article. The technique of leaving the pericardium open, enlarging the defect if it is small, is a described option after intrapericardial left pneumonectomy.Go 1 In fact, on the left side, differently than on the right side, the life-threatening complication is not the herniation of the heart but rather its strangulation through a small pericardial hole. Unfortunately, we have no personal experience to comment on this technique, because we always close any pericardial defect on both the right and left sides, as suggested by other authors.Go 2 However, we are a little concerned that "near-total pericardiectomy," as suggested by Weissberg, may cause any injury to the phrenic nerve, the function of which is also important after a pneumonectomy.Go 1

"To be or not to be," said Hamlet. "That is the question," he continued. "To Close or Not to Close," Weissberg entitled his letter. "This is not a question," we would continue—if you are on the left side and enlarge the defect with regard to the phrenic nerve.

References

  1. Goldstraw P. Pneumonectomy and its modifications. In: Shields TW, editor. General thoracic surgery. Baltimore: Williams & Wilkins; 1994. p. 421-6.
  2. Waters PF. Pneumonectomy. In: Pearson FG, Deslauriers J, Ginsberg RJ, Hiebert CA, McKneally MF, Urschel HC, editors. Thoracic surgery. New York. Churchill Livingstone; 1995. p. 844-8.




This Article
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