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JACC. Case Reports Dec 2023A 63-year-old male patient presented with chest pain and signs of volume overload. His work-up revealed a diagnosis of transient effusive constrictive pericarditis of...
A 63-year-old male patient presented with chest pain and signs of volume overload. His work-up revealed a diagnosis of transient effusive constrictive pericarditis of idiopathic etiology. Despite treatment with optimal medical therapy, he continued to experience persistent symptoms eventually requiring radical pericardiectomy.
PubMed: 38204553
DOI: 10.1016/j.jaccas.2023.102088 -
Vascular Health and Risk Management 2024We aim to access the effect of pericardiectomy for constrictive pericarditis with or without cardiopulmonary bypass. (Review)
Review
AIM
We aim to access the effect of pericardiectomy for constrictive pericarditis with or without cardiopulmonary bypass.
METHODS
This was a review of pericardiectomy for constrictive pericarditis.
RESULTS
Cardiopulmonary bypass is actually an important maneuver to attain complete relief of the constriction. The short additional time of cardiopulmonary bypass during the procedure has very little effect on the risk of morbidity of the main operation.
CONCLUSION
Incomplete pericardiectomy perhaps was the cause of postoperative remnant constriction and high diastolic filling pressure leading to multiorgan failure. Complete pericardiectomy (removal of phrenic-to-phrenic and the postero-lateral and inferior wall pericardial thickening) using cardiopulmonary bypass should be the routine for total relief of the constriction of the heart.
Topics: Humans; Pericarditis, Constrictive; Pericardiectomy; Cardiopulmonary Bypass; Postoperative Complications
PubMed: 38348404
DOI: 10.2147/VHRM.S439292 -
Turkish Thoracic Journal May 2022We operated on primary malignant melanoma of the lung, attaching the pericardium, diaphragm, and parietal pleura. A 48-year-old female was admitted to our hospital...
We operated on primary malignant melanoma of the lung, attaching the pericardium, diaphragm, and parietal pleura. A 48-year-old female was admitted to our hospital because of persistent dyspnea and cough. A preoperative computed tomography of the chest revealed 3 lesions in the right lung and a mass on the diaphragm between the right lung's lower lobe and heart. A middle lobectomy was performed. The mass on the diaphragm had invaded the diaphragm and pericardium strictly. With a pericardiectomy and a diaphragmatic resection, the mass was removed in an en-bloc manner. Adjuvant chemotherapy was started 1 month after surgery and consisted of 5 days course of iv injection of cisplatin (90 mg/kg). The follow-up period was 5 years and uneventful. For primary pulmonary melanoma, even if it has intrapulmonary metastases, surgery and adjuvant chemotherapy can provide uneventful survival for more than 5 years.
PubMed: 35579233
DOI: 10.5152/TurkThoracJ.2022.19062 -
The Pan African Medical Journal 2021To the best of our knowledge there are no publications about Tunisian experience in constrictive pericarditis (CP); the aim of this study was therefore to review our... (Review)
Review
To the best of our knowledge there are no publications about Tunisian experience in constrictive pericarditis (CP); the aim of this study was therefore to review our twenty-one years' experience in terms of clinical and surgical outcomes and risk factors of death after pericardiectomy. An analytic bicentric and retrospective study carried out on 25 patients (20 male) with CP underwent pericardiectomy, collected over a 21-years period. The mean age was 40.46±16.74 years [7.5-72]. The commonest comorbid factor was tabagism (52%). The most common etiology was tuberculosis (n = 11, 44%). Dyspnea was the most common functional symptom (n = 21, 84%). Pericardiectomy was performed in all our patients within 2.9±3.19 months after confirmation of diagnosis. It was subtotal in 96% of cases. The commonest postoperative complications are pleural effusion (20%). Dyspnea was regressed within 1.8 months in 80% of cases and clinical signs of right heart failure within a mean duration of 1.62 months in 53% of cases. Perioperative mortality was 12% (3 deaths), late mortality was 4% (1 patient). Cardiopulmonary bypass, New York Heart Association (NYHA) over class II and right ventricular dysfunction are the prognostic factors of mortality (p = 0.001, 0.046, 0.019). Tuberculosis as etiology of CP had no impact on mortality. CP is a rare disease, with non-specific clinical signs. Pericardiectomy is effective with a significant improvement of the functional status of patients and favorable outcome at short and long term nevertheless hospital mortality is not negligible and depends on many factors.
Topics: Adolescent; Adult; Aged; Cardiopulmonary Bypass; Child; Female; Hospital Mortality; Humans; Male; Middle Aged; Pericardiectomy; Pericarditis, Constrictive; Postoperative Complications; Retrospective Studies; Risk Factors; Tunisia; Young Adult
PubMed: 33912311
DOI: 10.11604/pamj.2021.38.141.22884 -
Journal of Cardiothoracic Surgery Jun 2021Pericardiectomy has traditionally carried relatively high perioperative mortality and morbidity, with few published reports of intermediate- and long- term outcomes. We...
PURPOSE
Pericardiectomy has traditionally carried relatively high perioperative mortality and morbidity, with few published reports of intermediate- and long- term outcomes. We investigated our 15-year experience performing pericardiectomy at our institution.
METHODS
Retrospective study of all patients who underwent pericardiectomy at our institution between 2005 and 2019. Baseline demographics, intraoperative details, and postoperative outcomes including long-term survival were analyzed.
RESULTS
Sixty-three patients were included in the study. 66.7% of subjects underwent isolated pericardiectomy while 33.3% underwent pericardiectomy concomitantly with another cardiac surgical procedure. The most common indications for pericardiectomy were constrictive (79.4%) and hemorrhagic (9.5%) pericarditis. Preoperatively, 76.2% of patients were New York Heart Association class II and III, while postoperatively, 71.4% were class I and II. One-, three-, five-, and ten- year overall mortality was 9.5, 14.3, 20.6, and 25.4%, respectively. Overall pericarditis recurrence rate was 4.8%.
CONCLUSION
Pericardiectomy carries relatively high overall mortality rates, which likely reflects underlying disease etiology and comorbidities. Patients with prior cardiac intervention, history of dialysis, and immunocompromised state are associated with worse outcomes.
Topics: Adult; Aged; Comorbidity; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Pericardiectomy; Pericarditis; Proportional Hazards Models; Retrospective Studies; Risk Factors; Stroke Volume; Tertiary Care Centers
PubMed: 34158104
DOI: 10.1186/s13019-021-01561-4 -
ESC Heart Failure Oct 2020We present the case of a 55-year-old female marathon runner who presented with progressive exercise intolerance and was diagnosed with effusive-constrictive...
We present the case of a 55-year-old female marathon runner who presented with progressive exercise intolerance and was diagnosed with effusive-constrictive pericarditis. Stereotypical findings of this challenging diagnosis are shown by transthoracic echocardiographic and right heart catheterization. We treated the patient with a parietal pericardiectomy and pericardial waffle procedure to relieve a thick and constrictive epicardium.
Topics: Echocardiography; Female; Humans; Middle Aged; Pericardial Effusion; Pericardiectomy; Pericarditis, Constrictive; Pericardium
PubMed: 32762001
DOI: 10.1002/ehf2.12926 -
Annals of Thoracic and Cardiovascular... 2024Pericardiectomy is the definitive treatment option for constrictive pericarditis and is associated with a high prevalence of morbidity and mortality. However,...
PURPOSE
Pericardiectomy is the definitive treatment option for constrictive pericarditis and is associated with a high prevalence of morbidity and mortality. However, information on the associated outcomes and risk factors is limited. We aimed to report the mid-term outcomes of pericardiectomy from a single center in China.
METHODS
We retrospectively reviewed data collected from patients who underwent pericardiectomy at our institute from April 2018 to January 2023.
RESULTS
Eighty-six consecutive patients (average age, 46.1 ± 14.7 years; 68.6 men) underwent pericardiectomy through midline sternotomy. The most common etiology was idiopathic (n = 60, 69.8%), and 82 patients (95.3%) were in the New York Heart Association function class III/IV. In all, 32 (37.2%) patients underwent redo sternotomies, 36 (41.9%) underwent a concomitant procedure, and 39 (45.3%) required cardiopulmonary bypass. The 30-day mortality rate was 5.8%, and the 1-year and 5-year survival rates were 88.3% and 83.5%, respectively. Multivariable analysis revealed that preoperative mitral insufficiency (MI) ≥moderate (hazard ratio [HR], 6.435; 95% confidence interval [CI] [1.655-25.009]; p = 0.007) and partial pericardiectomy (HR, 11.410; 95% CI [3.052-42.663]; p = 0.000) were associated with increased 5-year mortality.
CONCLUSION
Pericardiectomy remains a safe operation for constrictive pericarditis with optimal mid-term outcomes.
Topics: Humans; Pericarditis, Constrictive; Retrospective Studies; Male; Pericardiectomy; Middle Aged; Female; Risk Factors; Adult; Treatment Outcome; Time Factors; China; Risk Assessment; Aged; Postoperative Complications; Sternotomy
PubMed: 38811208
DOI: 10.5761/atcs.oa.24-00036 -
The Journal of Invasive Cardiology Oct 2022A 14-year-old boy presented with dyspnea on exertion and easy fatiguability for 1 year. He also had an episode of pedal edema 6 months prior, which resolved with...
A 14-year-old boy presented with dyspnea on exertion and easy fatiguability for 1 year. He also had an episode of pedal edema 6 months prior, which resolved with diuretics. He had a history of tuberculosis treated with a 6-month course of antitubercular therapy. After a series of tests and analyses, it was evident that longitudinal contraction of the left ventricle was preserved, whereas the circumferential contraction was severely impaired. Pericardial calcification also could be seen encircling the left and right ventricles. Pericardial calcification is evident in around 25% of cases of constrictive pericarditis and predominantly seen in those with tubercular and pyogenic etiology. The subepicardial myocardial fibers are responsible for radial shortening and subendocardial fibers are responsible for longitudinal shortening. In constrictive pericarditis, the involvement of the subepicardial fibers leads to reduction in the circumferential shortening. The patient was referred for pericardiectomy.
Topics: Adolescent; Angiography; Calcinosis; Diuretics; Heart Ventricles; Humans; Male; Pericardiectomy; Pericarditis, Constrictive
PubMed: 36201001
DOI: No ID Found -
Cureus Apr 2022This case report presents a 60-year-old gentleman with a significant smoking history and possible asbestos exposure who was referred to the emergency department for...
This case report presents a 60-year-old gentleman with a significant smoking history and possible asbestos exposure who was referred to the emergency department for atrial fibrillation with a rapid ventricular rate and symptoms of heart failure. Labs showed normal brain natriuretic peptide and troponin I. His echocardiography finding suggested constrictive pericarditis with an ejection fraction of 60%. A computed tomography scan was concerning for a pericardial mass. Left and right heart catheterization hinted more toward constrictive physiology; however, some findings were concerning for restrictive physiology. Hence, cardiac magnetic resonance imaging was done, which established the diagnosis of constrictive pericarditis. Pericardiectomy was planned with a maze procedure for atrial fibrillation. However, a malignant neoplasm was seen on a frozen biopsy. Hence, surgery was limited to partial pericardiectomy, as the patient had advanced infiltrative neoplasm that had resulted in constrictive pericarditis. The final pathology report confirmed the diagnosis of malignant pericardial mesothelioma mixed type. Malignancy is usually diagnosed in an advanced stage, like in our case, due to nonspecific initial presentation. A literature review suggests that there is a lack of established consensus on treatment. The response to therapy also seems to be poor and results only in palliation of symptoms, with a median survival of six months from diagnosis despite optimum medical management.
PubMed: 35602795
DOI: 10.7759/cureus.24270 -
Journal of Cardiovascular and Thoracic... 2021Tuberculous pericarditis continues to be a leading cause of chronic constrictive pericarditis (CCP) in developing countries. Echocardiography plays a key role in the...
Tuberculous pericarditis continues to be a leading cause of chronic constrictive pericarditis (CCP) in developing countries. Echocardiography plays a key role in the assessment and diagnosis. Twelve patients who underwent pericardiectomy for CCP in last 18 months of the study period were subjected to clinical and New York Heart Association (NYHA) functional class assessment along with comprehensive echocardiographic evaluation. The data were compared with their preprocedural status. Significant reduction was noted in the incidence of inferior vena cava (IVC) congestion( < 0.001) and mean left atrial (LA) size from 43.75 ± 4.43 mm to 31.58 ± 3.03 mm ( < 0.001), post pericardiectomy.Respiratory variation of 34.17 ± 8.76 % in the mitral E velocity was significantly reduced to 17 ± 3.69 % ( < 0.001) after surgery. Similarly, respiratory variation in tricuspid E velocities showed significant reduction from 62.17 ± 13.16 % to 32.58 ± 4.7 % ( < 0.001).Prior to pericardiectomy, medial e' and lateral e' mitral annular velocities was 15.5±1.24 cm/sec and13.08 ± 1.08 cm/sec, respectively. Following surgery, the medial e' and lateral e' was 12.5±1.17 cm/sec( = 0.001) and 15.42±1.83 ( = 0.004), respectively. Echocardiography provides useful insight in pericardial constriction hemodynamics and worthwhile effects of pericardiectomy.
PubMed: 34326972
DOI: 10.34172/jcvtr.2021.23