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JACC. Case Reports May 2021We report the case of a patient with severely calcified constrictive pericarditis and liver cirrhosis who underwent successful off-pump radical pericardiectomy. The...
We report the case of a patient with severely calcified constrictive pericarditis and liver cirrhosis who underwent successful off-pump radical pericardiectomy. The cardiac parameters significantly improved without severe complications. We demonstrate the usefulness of off-pump surgical treatment for constrictive pericarditis with liver cirrhosis. ().
PubMed: 34317632
DOI: 10.1016/j.jaccas.2021.03.024 -
JACC. Case Reports Sep 2023Parasitic constrictive pericarditis is a rare entity. We present a case of a 75-year-old man who presented with dyspnea, ascites, and pedal edema and was found to have...
Parasitic constrictive pericarditis is a rare entity. We present a case of a 75-year-old man who presented with dyspnea, ascites, and pedal edema and was found to have constrictive pericarditis on multimodality imaging with positive serology for . Treatment required ivermectin and radical pericardiectomy with significant clinical improvement. ().
PubMed: 37790764
DOI: 10.1016/j.jaccas.2023.101983 -
Clinical Medicine (London, England) Jan 2020Acute pericarditis accounts for ∼5% of presentations with acute chest pain. Tuberculosis is an important cause in the developing world, however, in the UK and other...
Acute pericarditis accounts for ∼5% of presentations with acute chest pain. Tuberculosis is an important cause in the developing world, however, in the UK and other developed settings, most cases are idiopathic/viral in origin. Non-steroidal anti-inflammatory drugs (NSAIDs) remain the cornerstone of treatment. At least one in four patients are at risk of recurrence. The addition of 3 months of colchicine can more than halve the risk of this (number needed to treat = four). Low-dose steroids can be helpful second-line agents for managing recurrences as adjuncts to NSAIDs and colchicine but should not be used as first-line agents. For patients failing this approach and/or dependent on corticosteroids, the interleukin-1β antagonist anakinra is a promising option, and for the few patients who are refractory to medical therapy, surgical pericardiectomy can be considered. The long-term prognosis is good with <0.5% risk of constriction for patients with idiopathic acute pericarditis.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Colchicine; Humans; Pericarditis; Prognosis; Recurrence
PubMed: 31941732
DOI: 10.7861/clinmed.cme.20.1.4 -
The Journal of Thoracic and... May 2020
Topics: Cardiac Surgical Procedures; Humans; Pericardiectomy; Postoperative Period; Ventricular Dysfunction, Right; Ventricular Function, Right
PubMed: 31301900
DOI: 10.1016/j.jtcvs.2019.05.064 -
Veterinary Sciences Aug 2021Idiopathic pericarditis (IP) and pericardial mesothelioma (PM) are causes of pericardial effusion in dogs. Pericardiectomy can be a definitive treatment in the case of...
Idiopathic pericarditis (IP) and pericardial mesothelioma (PM) are causes of pericardial effusion in dogs. Pericardiectomy can be a definitive treatment in the case of idiopathic pericardial effusion or a short-term intervention for mesothelioma. The aim of the present study was to investigate which histopathologic parameters are correlated with clinical outcomes in a cohort of dogs that underwent pericardiectomy. The histopathological findings of 22 IPs and 5 PMs were compared with clinical and survival data and the immunohistochemical characterization of immune cells (CD3, CD79α, Iba1). In IP, the mesothelium was lost in 20 cases, reactive in 9, atypical in 3, and mesothelial papillary hyperplasia (MPH) was observed in 4 cases. Numerous macrophages were found in both IPs and PMs especially at the superficial layer of the pericardium. T lymphocytes were observed in mild to moderate numbers and were more numerous than B lymphocytes in both IPs and PMs. MPH was correlated with the quantity of lymphoplasmacytic infiltrate in the superficial layer, inversely related to the thickness of the pericardium, and associated with a longer overall survival. Pericardial fibrosis was present in 19 out of 22 IPs and in all mesotheliomas and was correlated with increased time from initial presentation and pericardiectomy and lymphoplasmacytic infiltrate in the deep zone. Pericardial thickness was correlated with the amount of lymphoplasmacytic and macrophagic infiltrate in the deep zone. Mesothelioma was associated with an increased number of pericardiocentesis procedures before pericardiectomy and with the presence of macrophages in the superficial pericardial layer, edema, fibrin, and hemorrhage. Disease-free interval and overall survival were significantly shorter in patients with mesothelioma compared with IP.
PubMed: 34437484
DOI: 10.3390/vetsci8080162 -
International Journal of Surgery Case... Jul 2024The interactions between the heart and liver have been known for a long time, pericarditis constrictive could cause congestive hepatopathy via right-sided heart failure....
INTRODUCTION
The interactions between the heart and liver have been known for a long time, pericarditis constrictive could cause congestive hepatopathy via right-sided heart failure. Liver cirrhosis correlates with a high risk of mortality so perioperative management greatly influences outcomes.
CASE PRESENTATION
An Indonesian man, 50 years old, complained of breath shortness. The patient had a history of pulmonary tuberculosis and was declared cured 30 years ago. The patient began experiencing fatigue 14 years ago, and the patient was diagnosed with constrictive pericarditis 5 years ago. Currently, the patient has an increased jugular venous pressure of 9 cmHO and abnormal laboratory indicators, including a platelet count of 121,000/μL, albumin count of 3.41 g/L, direct bilirubin count of 0.7 mg/dL, total bilirubin count of 1.4 mg/dL, and INR of 1.4. Echocardiography revealed left ventricle hypertrophy, diastolic dysfunction, and right ventricle failure. Cardiac CT scan showed pericardial calcification. Abdominal ultrasound showed liver congestive and splenomegaly. Transient elastography showed severe fibrosis in liver and stiffness in spleen. The patient underwent pericardiectomy with CTP score of 6 and MELD of 12. The surgery was successful, and the complaint was reduced. The patient experienced an improvement in his condition and able to carry out activities well after 2 years post-surgery.
DISCUSSION
The patient has no contraindications to pericardiectomy, CTP class A (5-6) and MELD score <13.5 has a low risk of mortality.
CONCLUSION
CTP and MELD scores predict life expectancy in post-surgery cardiac cirrhosis patients.
PubMed: 38848659
DOI: 10.1016/j.ijscr.2024.109843 -
Experimental Physiology May 2023What is the central question of this study? Invasive cardiovascular instrumentation can occur through closed- or open-chest approaches. To what extent will sternotomy...
NEW FINDINGS
What is the central question of this study? Invasive cardiovascular instrumentation can occur through closed- or open-chest approaches. To what extent will sternotomy and pericardiotomy affect cardiopulmonary variables? What is the main finding and its importance? Opening of the thorax decreased mean systemic and pulmonary pressures. Left ventricular function improved, but no changes were observed in right ventricular systolic measures. No consensus or recommendation exists regarding instrumentation. Methodological differences risk compromising rigour and reproducibility in preclinical research.
ABSTRACT
Animal models of cardiovascular disease are often evaluated by invasive instrumentation for phenotyping. As no consensus exists, both open- and closed-chest approaches are used, which might compromise rigour and reproducibility in preclinical research. We aimed to quantify the cardiopulmonary changes induced by sternotomy and pericardiotomy in a large animal model. Seven pigs were anaesthetized, mechanically ventilated and evaluated by right heart catheterization and bi-ventricular pressure-volume loop recordings at baseline and after sternotomy and pericardiotomy. Data were compared by ANOVA or the Friedmann test where appropriate, with post-hoc analyses to control for multiple comparisons. Sternotomy and pericardiotomy caused reductions in mean systemic (-12 ± 11 mmHg, P = 0.027) and pulmonary pressures (-4 ± 3 mmHg, P = 0.006) and airway pressures. Cardiac output decreased non-significantly (-1329 ± 1762 ml/min, P = 0.052). Left ventricular afterload decreased, with an increase in ejection fraction (+9 ± 7%, P = 0.027) and coupling. No changes were observed in right ventricular systolic function or arterial blood gases. In conclusion, open- versus closed-chest approaches to invasive cardiovascular phenotyping cause a systematic difference in key haemodynamic variables. Researchers should adopt the most appropriate approach to ensure rigour and reproducibility in preclinical cardiovascular research.
Topics: Swine; Animals; Pericardiectomy; Sternotomy; Reproducibility of Results; Hemodynamics; Models, Animal
PubMed: 36892095
DOI: 10.1113/EP090919 -
Multimedia Manual of Cardiothoracic... Sep 2020This video tutorial presents the reconstruction of the intervalvular fibrosa and a triple valve replacement, due to prosthetic valve endocarditis, in a patient with...
This video tutorial presents the reconstruction of the intervalvular fibrosa and a triple valve replacement, due to prosthetic valve endocarditis, in a patient with previous chest irradiation and bicuspid aortic valve replacement. Constrictive pericarditis was also present since the original operation. A detailed step-by-step demonstration of the reconstruction of the intervalvular fibrosa and debridement of extensive prosthetic valve endocarditis with paravalvular root abscess are provided. A secondary sternotomy was performed and, in the process, the ascending aorta was injured, with associated life-threatening bleeding. Manual compression was applied while peripheral cannulation and cardiopulmonary bypass were started. The bleeding was controlled with cooling and circulatory arrest and the ascending aorta was replaced with a Dacron graft. The intervalvular fibrosa was reconstructed using a folded pericardial patch. Aortic root replacement with a cryopreserved homograft was performed and the mitral and tricuspid valves were replaced with tissue valve prostheses. A complete pericardiectomy was performed. The chest was left packed with cotton due to diffuse bleeding. At the time of the delayed chest closure, a permanent epicardial pacemaker was implanted.
Topics: Aorta; Endocarditis, Bacterial; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Heart Valves; Humans; Intraoperative Complications; Male; Middle Aged; Pericardiectomy; Pericarditis, Constrictive; Prosthesis-Related Infections; Reoperation; Treatment Outcome; Vascular Grafting
PubMed: 33000922
DOI: 10.1510/mmcts.2020.052 -
Journal of Cardiothoracic Surgery Mar 2015Pericardiectomy is associated with a high prevalence of morbidity and mortality. We evaluated the predictors of in-hospital complications and outcome for pericardiectomy...
OBJECTIVE
Pericardiectomy is associated with a high prevalence of morbidity and mortality. We evaluated the predictors of in-hospital complications and outcome for pericardiectomy procedure for patients with constrictive pericarditis (CP) in a single-center in China.
METHODS
One-hundred sixty-five patients who underwent pericardiectomy for CP between January 1990 and December 2012 at our hospital were evaluated.
RESULTS
The mean age of the study cohort was 36.79 ± 18.52 years. The approach was through a median sternotomy in 91.5% of patients. Cardiopulmonary bypass was used in 14.5% (24/165 patients). Unadjusted rates of mortality and complication were approximately 5.4% and 23%, respectively. The main cause of death was severe low cardiac output syndrome. Major complications were postoperative low cardiac output syndrome, reoperation for bleeding, pneumonia, mediastinitis, chylothorax and cerebral infarction. One-year survival was 92%. One-year follow-up revealed that New York Heart Association functional class III or IV, age, intraoperative use of cardiac pulmonary bypass and hemodialysis were associated with increased mortality and morbidity.
CONCLUSIONS
Total pericardiectomy is associated with lower perioperative and late mortality, and the extent of pericardial resection should be decided according to individual conditions. Perioperative management and complete release of the thickened pericardium of the left ventricle should prevent postoperative complications.
Topics: Adolescent; Adult; Aged; Cardiac Output, Low; Cardiopulmonary Bypass; Coronary Artery Bypass; Female; Humans; Male; Middle Aged; Pericardiectomy; Pericarditis, Constrictive; Prognosis; Reoperation; Retrospective Studies; Risk Factors; Sternotomy; Treatment Outcome; Young Adult
PubMed: 25887705
DOI: 10.1186/s13019-015-0237-6 -
PloS One 2019Heart failure is associated with exercise intolerance and sleep- disordered breathing; however, studies in patients with chronic constrictive pericarditis are scarce....
BACKGROUND
Heart failure is associated with exercise intolerance and sleep- disordered breathing; however, studies in patients with chronic constrictive pericarditis are scarce. The purpose of our study was to assess exercise capacity and sleep in patients with chronic constrictive pericarditis (CCP) undergoing a pericardiectomy.
METHODS
We studied consecutive patients scheduled for pericardiectomy due to symptomatic CCP. Were performed quality of life (Minnesota Living with Heart Failure Questionnaire-MLHFQ) and sleep questionnaires (Epworth, Pittsburgh Sleep Quality Index-PSQI), serum B-type natriuretic peptide (BNP), serum C-reactive protein, transthoracic echocardiography, cardiopulmonary exercise test and overnight polysomnography immediately before and six months after pericardiectomy.
RESULTS
Twenty-five patients (76% males, age: 45.5±13.8 years, body mass index: 24.9±3.7 kg/m2, left ventricular ejection fraction: 60±6%) with CCP (76% idiopathic, 12% tuberculosis) were studied. As compared to the preoperative period, pericardiectomy resulted in reduction in BNP (143 (83.5-209.5) vs 76 (40-117.5) pg/mL, p = 0.011), improvement in VO2 peak (18.7±5.6 vs. 25.2±6.3 mL/kg/min, p<0.001), quality of life (MLHFQ score 62 (43,5-77,5) vs. 18 (8,5-22), p<0,001) and sleep (PSQI score 7.8±4.1 vs. 4.7±3.7, p<0.001) and no significant change in sleep disordered breathing (apnea hypopnea index-AHI 15.6 (8.3-31.7) vs. 14.6 (5.75-29.9) events/h, p = 0.253).
CONCLUSION
Patients with symptomatic CCP showed reduced exercise capacity and sleep-disordered breathing. After pericardiectomy, there was improvement in exercise capacity and neutral effect on sleep-disordered breathing.
Topics: Adult; C-Reactive Protein; Echocardiography; Exercise Tolerance; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Pericardiectomy; Pericarditis, Constrictive; Polysomnography; Prospective Studies; Sleep; Surveys and Questionnaires; Treatment Outcome
PubMed: 31603935
DOI: 10.1371/journal.pone.0223838