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Multimedia Manual of Cardiothoracic... Oct 2021Pericarditis is the most common form of pericardial disease. Its exact incidence remains unknown, probably because many cases resolve without diagnosis. Indications for...
Pericarditis is the most common form of pericardial disease. Its exact incidence remains unknown, probably because many cases resolve without diagnosis. Indications for pericardiectomy from the standpoint of the cardiac surgeon are based mainly on the physiopathology of 2 different entities that can overlap: inflammatory or relapsing pericarditis and constrictive pericarditis. Surgical indications are not always straightforward. Patients with inflammatory or relapsing pericarditis may undergo radical pericardiectomy because they experience severe symptoms despite maximal medical treatment or have sequelae from the medical treatment. Pericardiectomy is the standard treatment in patients with chronic constrictive pericarditis and persistent symptoms who are in New York Heart Association functional class III or IV and a class I recommendation in the European Society of Cardiology/European Association of Cardio-Vascular Surgery guidelines. The goal of surgery is always complete removal of any site of inflammation through a radical pericardiectomy.
Topics: Humans; Pericardiectomy; Pericarditis, Constrictive
PubMed: 34817937
DOI: 10.1510/mmcts.2021.069 -
JTCVS Techniques Jun 2022The robotic cardiac surgery program at our current institution began in 2013 with an experienced and dedicated team. This review analyzes early outcomes in the first...
OBJECTIVE
The robotic cardiac surgery program at our current institution began in 2013 with an experienced and dedicated team. This review analyzes early outcomes in the first 1103 patients.
METHODS
We reviewed all robotic procedures between July 2013 and February 2021. Primary outcomes were mortality and perioperative morbidity. Our robotic approach is totally endoscopic for all cases: off-pump for coronary and epicardial procedures, and on-pump with the endoballoon for mitral valve and other intracardiac procedures.
RESULTS
There were 1103 robotic-assisted cardiac surgeries over 7 years. A total of 585 (53%) were off-pump totally endoscopic coronary artery bypasses, 399 (36%) intracardiac cases (including isolated and concomitant mitral valve procedures, isolated tricuspid valve repair, CryoMaze, atrial or ventricular septal defect repair, benign cardiac tumor, septal myectomy, partial anomalous pulmonary venous drainage, and aortic valve replacement); 80 (7%) epicardial electrophysiology-related procedures (epicardial atrial fibrillation ablation, left atrial appendage ligation, lead placement, and ventricular tachycardia ablation); and 39 (4%) other epicardial procedures (pericardiectomy, unroofing myocardial bridge). Mortality was 1.2% (observed/expected ratio, 0.7). In the totally endoscopic coronary artery bypass and intracardiac groups, mortality was 1.0% (observed/expected, 0.6) and 1.5% (observed/expected, 0.87), respectively. There were 8 conversions to sternotomy (0.7%) and 24 (2.2%) take-backs for bleeding. Mean hospital and intensive care unit lengths of stay were 2.74 ± 1.26 days and 1.28 ± 0.57 days, respectively.
CONCLUSIONS
This experience demonstrates that a robotic endoscopic approach can safely be used in a multitude of cardiac surgical procedures both on- and off-pump with excellent early outcomes. An experienced surgeon and team are necessary. Longer-term follow-up is warranted.
PubMed: 35711214
DOI: 10.1016/j.xjtc.2021.12.018 -
Portuguese Journal of Cardiac Thoracic... Apr 2021Our objective was to examine the results of ECMO post cardiotomy in Centro Hospitalar Universitário S. João (CHUSJ).
OBJECTIVES
Our objective was to examine the results of ECMO post cardiotomy in Centro Hospitalar Universitário S. João (CHUSJ).
METHODS
Between 2011 and 2019, 13 patients were cannulated for refractory cardiogenic shock post-cardiotomy; 8 (61,5%) male and 5 (38,5%) female. Patients under 18 years old were excluded. Data was collected from hospital archives concerning preoperative comorbidities, open-heart surgery procedure, dates of ECMO cannulation and decannulation, postoperative complications, hospital mortality and cause of death. Follow-up was obtained by review of the last outpatient observation. The outcomes investigated were hospital mortality and survival at 12, 36 and 60 months.
RESULTS
After a median ECMO-VA therapy of 6 days (1-16 days), 7 (53,8%) patients were successfully decannulated; from these 2 succumbed from stroke and septic shock, one is still in intermediate care convalescing steadily and 4 were discharged. Overall 8 (61,5%) patients died. 5 (38,5%) survived, 4 were discharged home and 1 is still in intermediate care. Survival (after discharge) at 12, 36 and 60 months was respectively 25%, 16,7% and 8,3%. Regarding postoperative complications, reoperation for bleeding was necessary in 5 (38.5%), stroke was diagnosed in 2 (15,4%), dialysis in 6 (46,2%), leg ischemia affected 5 (38,5%) and mediastinitis occurred in 1 (7,7%).
CONCLUSIONS
VA ECMO saves a life in each three patients suffering from refractory cardiogenic shock after cardiac surgery. Despite risks associated with advanced cardiopulmonary support, survivors maintain good health condition.
Topics: Adolescent; Cardiac Surgical Procedures; Extracorporeal Membrane Oxygenation; Female; Humans; Male; Pericardiectomy; Postoperative Complications; Retrospective Studies; Shock, Cardiogenic
PubMed: 33834657
DOI: No ID Found -
JFMS Open Reports 2022An 11-year-old male neutered domestic shorthair cat was presented with a 4-week history of an intermittent cough and dyspnoea. A pleural effusion was identified, which...
CASE SUMMARY
An 11-year-old male neutered domestic shorthair cat was presented with a 4-week history of an intermittent cough and dyspnoea. A pleural effusion was identified, which was confirmed as chyle. Echocardiography and CT revealed a 16 mm mass cranial to the heart, which was invading the cranial vena cava. Because of the location of the mass, it was assumed that chylothorax had developed as a result of direct disruption of the thoracic duct by the tumour or secondarily to central venous hypertension. An exploratory thoracotomy was performed, and the mass, which originated within the wall of the cranial vena cava, was excised with narrow gross margins. Histopathology and immunohistochemistry were consistent with a chemodectoma with residual tumour cells at the surgical margin. Given the residual microscopic disease, adjuvant treatment with toceranib phosphate was initiated. The cat remained well for the duration of treatment and was euthanased 31 months after diagnosis when CT identified recurrent pleural effusion, a heart base mass with cranial vena cava and azygos vein invasion.
RELEVANCE AND NOVEL INFORMATION
Chemodectomas are rare in cats, with only 13 cases reported in the literature to date, and all were located in either the aortic or carotid body. The reported survival with partial resection and/or subtotal pericardiectomy was 13-19 months. Treatment of feline chemodectomas with toceranib phosphate has not been previously reported. To our knowledge, this is the first description of the surgical management of a feline vena cava chemodectoma, combined with adjuvant toceranib phosphate, resulting in a prolonged survival.
PubMed: 35811937
DOI: 10.1177/20551169221106990 -
Cureus May 2023A 65-year-old male presented with chest pain, tachycardia, tachypnea, and diminished breath sounds. His lab investigations revealed an elevated leukocyte count,...
A 65-year-old male presented with chest pain, tachycardia, tachypnea, and diminished breath sounds. His lab investigations revealed an elevated leukocyte count, erythrocyte sedimentation rate, and B-type natriuretic peptide. Transthoracic echocardiography and chest imaging revealed the presence of pericardial effusion without tamponade and he was treated for presumed acute idiopathic pericarditis. He was started on indomethacin and colchicine but he stopped them prematurely due to side effects. Subsequently, he developed pleural effusions and ascites requiring multiple thoracenteses and paracenteses. Due to equivocal echocardiographic findings, he underwent invasive hemodynamic measurements which demonstrated equalization of filling pressures and ventricular interdependence, confirming constrictive pericarditis. Due to ongoing pericardial inflammation on cardiovascular magnetic resonance imaging, he was treated with a prednisone taper. Due to persistent symptoms and fibrosis of the pericardium on cross-section imaging, he underwent pericardiectomy. He did well with the procedure and has had an uneventful clinical follow-up.
PubMed: 37362484
DOI: 10.7759/cureus.39485 -
Circulation. Cardiovascular Imaging Oct 2021Worsening tricuspid regurgitation (TR) severity may occur after pericardiectomy surgery for constrictive pericarditis patients; however, its mechanisms and predictors...
BACKGROUND
Worsening tricuspid regurgitation (TR) severity may occur after pericardiectomy surgery for constrictive pericarditis patients; however, its mechanisms and predictors are not well established. We evaluated the clinical characteristics, associated factors, and outcomes of worsening TR after pericardiectomy.
METHODS
Consecutive patients undergoing pericardiectomy for constrictive pericarditis without tricuspid valve surgery and with pre- and postoperative echocardiography available during 2000 to 2017 were retrospectively studied. Clinical, imaging, hemodynamic, and mortality characteristics were analyzed by those with and without worsening TR by at least one grade.
RESULTS
Among 381 patients (age 61 [17] years, 318 [83.5%] male), 193 (50.7%) had worsening TR post-operatively, and 75 died during the 2.5 (5.4) years follow-up. In univariable analysis, worsening TR was associated with a history of congestive heart failure (47.2% versus 31.9%, =0.003), increased left atrial volume indexed (23 versus 20 mL/m, =0.020), reduced right ventricular fractional area change (47% versus 54%, <0.001), and worsening mitral regurgitation (39.7% versus 16.6%, <0.001). Worsened TR had a trend toward reduced survival during follow-up (log-rank =0.080), especially those with worsened TR but no recovery of TR grade on subsequent echocardiography within the first year compared with those without worsened TR (log-rank =0.02). In multivariable analysis, right ventricular fractional area change, left atrial volume indexed, left ventricular mass indexed, pulmonary artery systolic pressure, and right atrial pressure/pulmonary capillary wedge pressure ratio were most associated with worsened TR, while blood urea nitrogen, hematocrit, lateral and medial e' tissue Doppler and heart rate were most associated with mortality during follow-up.
CONCLUSIONS
Worsening TR severity was prevalent after pericardiectomy and had a trend toward reduced survival, especially if TR severity did not recover on subsequent echocardiography. Presence of parameters associated with worsened TR and reduced survival should alert clinicians to carefully manage these patients during follow-up.
Topics: Disease Progression; Echocardiography, Doppler; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pericardiectomy; Pericarditis, Constrictive; Postoperative Complications; Retrospective Studies; Time Factors; Tricuspid Valve Insufficiency
PubMed: 34607446
DOI: 10.1161/CIRCIMAGING.121.012948 -
Rheumatology International Jul 2022IgG4-related disease (IgG4-RD) is a systemic, immune-mediated fibro-inflammatory disease that can affect virtually every organ system. It is usually insidious in onset... (Review)
Review
IgG4-related disease (IgG4-RD) is a systemic, immune-mediated fibro-inflammatory disease that can affect virtually every organ system. It is usually insidious in onset and often mimics malignant or other inflammatory disorders. Diagnosis frequently requires a combination of clinical, serological, radiographic, and histopathological features, including increased serum-IgG4 levels and tissue infiltration of IgG4-positive plasma cells with associated fibrosis. Unlike more frequently affected sites, including the hepatobiliary system, salivary glands and retroperitoneum, pericardial involvement of IgG4-RD has only rarely been described. We report the case of a 76-year-old woman presenting with refractory pericarditis and imminent cardiac tamponade, successfully treated with therapeutic pericardiectomy. A diagnosis of IgG4-RD was made based on elevated serum-IgG4 levels and the presence of typical pericardial histopathological findings, meeting all 3 of the 2011 comprehensive diagnostic criteria for IgG4-RD. Following pericardiectomy, the patient remained in remission without a need for glucocorticoids or additional immunosuppressive therapy. Adding to this case, we reviewed the literature for previously described cases of IgG4-RD presenting with pericarditis and described their characteristics and the available treatment options. Our case-based literature review provides a clear overview of the diagnostic process for IgG4-RD and the need to apply classification criteria with the necessary caution, particularly in the case of rare disease manifestations, including pericarditis.
Topics: Aged; Autoimmune Diseases; Female; Glucocorticoids; Humans; Immunoglobulin G; Immunoglobulin G4-Related Disease; Pericarditis
PubMed: 34255183
DOI: 10.1007/s00296-021-04946-9 -
The American Journal of Cardiology May 2024In patients with cardiac amyloidosis, pericardial involvement is common, with up to half of patients presenting with pericardial effusions. The pathophysiological... (Review)
Review
In patients with cardiac amyloidosis, pericardial involvement is common, with up to half of patients presenting with pericardial effusions. The pathophysiological mechanisms of pericardial pathology in cardiac amyloidosis include chronic elevations in right-sided filling pressures, myocardial and pericardial inflammation due to cytotoxic effects of amyloid deposits, and renal involvement with subsequent uremia and hypoalbuminemia. The pericardial effusions are typically small; however, several cases of life-threatening cardiac tamponade with hemorrhagic effusions have been described as a presenting clinical scenario. Constrictive pericarditis can also occur due to amyloidosis and its identification presents a clinical challenge in patients with cardiac amyloidosis who concurrently manifest signs of restrictive cardiomyopathy. Multimodality imaging, including echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, is useful in the evaluation and management of this patient population. The recognition of pericardial effusion is important in the risk stratification of patients with cardiac amyloidosis as its presence confers a poor prognosis. However, specific treatment aimed at the effusions themselves is seldom indicated. Cardiac tamponade and constrictive pericarditis may necessitate pericardiocentesis and pericardiectomy, respectively.
PubMed: 38740164
DOI: 10.1016/j.amjcard.2024.05.007 -
Journal of Veterinary Cardiology : the... Feb 2022An 11-year-old neutered male Border Terrier presented for pericardiectomy after a nine-month history of tricavitary effusion, dyspnoea and lethargy. Transthoracic...
An 11-year-old neutered male Border Terrier presented for pericardiectomy after a nine-month history of tricavitary effusion, dyspnoea and lethargy. Transthoracic echocardiography revealed a fluid-filled structure at the heart base, starting at the mid-right ventricle and extending to the middle of the right atrium. Almost complete compression of the right atrium and the cranial vena cava was noted. Thoracic computed tomography revealed a heterogeneously enhancing and poorly marginated mass within the cranial aspect of the pericardium. A median sternotomy and subtotal pericardiectomy were performed. A non-distinct fluid-filled structure within the pericardium adhered to the epicardium was visualised. The structure was removed via marsupialisation along with extirpation of enlarged sternal lymph nodes. Histopathological examination of the sternal lymph nodes revealed expansile, well-demarcated, unencapsulated nodules of neoplastic cells consistent with a neuroendocrine tumour suspected to be thyroid in origin. After surgery, intractable pleural effusion resulted in euthanasia. Intrapericardial ectopic thyroid tumours are rarely reported in animals. The location of the mass and unusual presentation may have made it challenging for echocardiography to identify this neoplasia. Thoracic computed tomography at an earlier stage may have identified the neoplasia and potentially allowed for surgical intervention.
Topics: Animals; Dog Diseases; Dogs; Echocardiography; Euthanasia, Animal; Male; Neuroendocrine Tumors; Pericardiectomy; Pericardium
PubMed: 34979483
DOI: 10.1016/j.jvc.2021.12.007 -
Cureus Dec 2022Cardiac tamponade is a rare presentation in breast cancer and may be associated with poor prognosis. In this article, we reviewed the characteristics and survival... (Review)
Review
Cardiac tamponade is a rare presentation in breast cancer and may be associated with poor prognosis. In this article, we reviewed the characteristics and survival outcomes of patients with breast cancer who developed cardiac tamponade. Three databases (PubMed, EMBASE and SCOPUS) were searched for relevant articles published from 1978 to 2022 and 16 articles were identified comprising 64 cases. The median age of the cases was 52 years. Cardiac tamponade was diagnosed with echocardiogram or computerized tomography of the chest or both in 91.9%, 1.6% and 6.5% of the cases, respectively. Cytology of the pericardial fluid was done in 90.5% of the cases while biopsy in addition to cytology was done in 9.5% of cases. Tamponade was proven to be malignant in 97.4% of the cases. The initial treatment for tamponade was pericardiocentesis. Adjunct therapies ranged from the insertion of a pericardial window, pericardiectomy, radiotherapy and chemotherapy. The median time from the first treatment of breast cancer to the onset of tamponade was 24 months while the median survival following diagnosis of tamponade was 13 months. There was no significant correlation (spearman rank-sum correlation coefficient= 0.35, p = 0.165) between time to tamponade (interval time from the first diagnosis of breast cancer and the onset of cardiac tamponade) and survival. Cardiac tamponade may adversely affect survival in patients with breast cancer. Early diagnosis with echocardiogram and cytology may guide management and expectations. Further observational studies are needed to determine the predictors of cardiac tamponade and optimal treatment in patients with breast cancer.
PubMed: 36721600
DOI: 10.7759/cureus.33123