ABSTRACT
This article describes three new techniques for completely closing the pericardial space. They entail the creation of three flaps of living, vascularized tissue: two pericardial and one pleural. Utilizing advancement and rotational plastic surgical principles, complete closure can be performed without tension or the use of any pericardial substitutes. These flaps create great laxity and tissue redundancy during closure, greatly reducing any possibility of graft compromise or impairment of myocardial diastolic function. There are three types of closure described, types I and Ia, and type II, creating great versatility in closing the pericardial space (and adaptability to the surgeon's preferences). These flaps are able to create pericardial tissue redundancy (and therefore laxity upon closure) in both the transverse and longitudinal directions, and are therefore suitable to any cardiac procedure. The advantages of these techniques in creating a tension-free complete closure include the possibility of a safer reoperation if needed. The DiMarco-Jurado pleuropericardioplasties as described are quick and easy methods to completely close the pericardial space without tension and may be utilized after all adult (and possibly pediatric) primary cardiac procedures.