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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 -
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 -
Journal of Cardiovascular Imaging Oct 2021
PubMed: 34080353
DOI: 10.4250/jcvi.2021.0074 -
Kardiochirurgia I Torakochirurgia... Sep 2021Constrictive pericarditis is the endpoint of the natural history of acute pericarditis of different aetiologies where a chronic inflammatory process results in a...
INTRODUCTION
Constrictive pericarditis is the endpoint of the natural history of acute pericarditis of different aetiologies where a chronic inflammatory process results in a thickened, fibrotic and inelastic pericardium with consequent impairment of diastolic function and systemic congestion.
AIM
To evaluate the clinical features, diagnosis, surgical management and outcome of patients with constrictive pericarditis as managed in a local setting of a tertiary hospital in Ghana.
MATERIAL AND METHODS
A retrospective review of the medical records of patients who had undergone pericardiectomy for constrictive pericarditis at a teaching hospital.
RESULTS
Ten patients underwent pericardiectomy for the period of study. There were 8 (80%) males and 2 (20%) females. The mean age was 20.4 ±17.2 years. Six of the patients 6 (60%) were in NYHA class III. Preoperative diagnostics included chest X-ray, echocardiography, and computed tomography scan. The surgical approach for the pericardiectomy was median sternotomy. The mean operative time was 159.9 ±43.0 min. The mean postoperative days spent before being discharged was 6.9 ±2.3 days. Nine (90%) of the patients were in NYHA class I after a mean follow-up of 19.3 ±16.7 months. One patient died 6 weeks after surgery with heart failure and one patient was lost to follow-up.
CONCLUSIONS
Surgical pericardiectomy via median sternotomy is still the standard modality of treatment for constrictive pericarditis with excellent results even in resource constraint settings.
PubMed: 34703474
DOI: 10.5114/kitp.2021.109390 -
BMC Cardiovascular Disorders Feb 2022Constrictive pericarditis remains a problematic diagnosis and a thorough investigation is critical. Among possible aetiologies, immunoglobulin-G4 (IgG4)-related...
BACKGROUND
Constrictive pericarditis remains a problematic diagnosis and a thorough investigation is critical. Among possible aetiologies, immunoglobulin-G4 (IgG4)-related pericardial disease is an unusual cause of pericardial constriction. We report a challenging diagnostic case of pericardial constriction due to IgG4-related disease.
CASE PRESENTATION
A 68-year old male with a history of inferior myocardial infarction with right ventricle (RV) involvement was thrice-hospitalized due to marked ascites and peripheral oedema. Systemic congestion was initially attributed to RV dysfunction due to previous infarction. Yet, at the final admission, a re-assessment echocardiogram followed by cardiac computed tomography, magnetic resonance and right heart catheterization raised a possible diagnosis of constrictive pericarditis with a finding of abnormal pulmonary venous return. Patient therefore underwent pericardiectomy and surgical correction of pulmonary venous return. Pericardium histology revealed an IgG4-related pericardial constriction. Patient was later discharged on corticosteroids with marked symptomatic improvement.
CONCLUSION
IgG4-related disease remains a rare cause of pericardium constriction while also presenting a challenging diagnosis in everyday clinical practice. This case exemplifies the difficulties faced by clinicians when reviewing a possible case of constrictive pericarditis, while highlighting the importance of a multimodality assessment.
Topics: Aged; Cardiac Catheterization; Echocardiography; Humans; Immunoglobulin G; Magnetic Resonance Imaging, Cine; Male; Pericarditis, Constrictive; Pericardium
PubMed: 35120437
DOI: 10.1186/s12872-022-02468-1 -
Indian Journal of Thoracic and... Jul 2019Pneumopericardium is the presence of air in the pericardial cavity. It is a rare case entity that has been reported most commonly after trauma, or spontaneously without...
Pneumopericardium is the presence of air in the pericardial cavity. It is a rare case entity that has been reported most commonly after trauma, or spontaneously without any underlying cause in a healthy adult. Pneumopericardium following pericardiocentesis has been rarely reported in the literature. Pneumopericardium is often self-resolving and rarely requires a pericardial drain for treatment. We report a case of pneumopericardium presented with tamponade physiology following pericardiocentesis for tubercular pericardial effusion, requiring emergency pericardiectomy.
PubMed: 33061035
DOI: 10.1007/s12055-018-00785-9