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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 -
The Annals of Thoracic Surgery Aug 2012The leading causes of constrictive pericarditis have changed over time leading to a commensurate change in the indications and complexity of surgical pericardiectomy. We...
BACKGROUND
The leading causes of constrictive pericarditis have changed over time leading to a commensurate change in the indications and complexity of surgical pericardiectomy. We evaluated our single-center experience to define the etiologies, risk factors, and outcomes of pericardiectomy in a modern cohort.
METHODS
We retrospectively reviewed our institutional database for all patients who underwent total or partial pericardiectomy. Demographic, comorbid, operative, and outcome data were evaluated. Survival was assessed by the Kaplan-Meier method. Multivariable Cox proportional hazards regression models examined risk factors for mortality.
RESULTS
From 1995 to 2010, 98 adults underwent pericardiectomy for constrictive disease. The most common etiologies were idiopathic (n=44), postoperative (n=30), and post radiation (n=17). Total pericardiectomy was performed in 94 cases, most commonly through a sternotomy (n=93). Thirty-three cases were redo sternotomies, 34 underwent a concomitant procedure, and 34 required cardiopulmonary bypass. Overall in-hospital, 1-year, 5-year, and 10-year survival rates were 92.9%, 82.5%, 64.3%, and 49.2%, respectively. Survival differed sharply by etiology with idiopathic, postoperative, and post-radiation 5-year survivals of 79.8%, 55.9%, and 11.0%, respectively (p<0.001). On multivariable analysis, only the need for cardiopulmonary bypass (hazard ratio [HR]: 21.2, p=0.02) was predictive of 30-day mortality while post-radiation etiology (HR: 3.19, p=0.02) and hypoalbuminemia (HR: 0.57, p=0.03) were associated with increased 10-year mortality.
CONCLUSIONS
Although survival varies significantly by etiology, pericardiectomy continues to be a safe operation for constrictive pericarditis. Post-radiation pericarditis and hypoalbuminemia are significant risk factors for decreased long-term survival.
Topics: Female; Humans; Male; Middle Aged; Pericardiectomy; Pericarditis, Constrictive; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 22621875
DOI: 10.1016/j.athoracsur.2012.03.079 -
Journal of Clinical Microbiology Feb 1983A pericardial effusion was diagnosed by echocardiography in a 49 year old man who suffered acute cough, orthopnea, and chest pain. Because of a positive tuberculin skin...
A pericardial effusion was diagnosed by echocardiography in a 49 year old man who suffered acute cough, orthopnea, and chest pain. Because of a positive tuberculin skin test, mycobacteria were initially suspected as the cause of the pericarditis. The patient was therefore treated with antituberculosis drugs. The pericardial effusion failed to resolve, however, and pericardiectomy was performed. Culture of the pericardial fluid yielded pure Fusobacterium nucleatum growth. The patient responded to antibiotic therapy and was in good health 3 weeks after being discharged from the hospital. This represents the first report of F. nucleatum pericarditis.
Topics: Fusobacterium Infections; Humans; Male; Middle Aged; Pericarditis
PubMed: 6833485
DOI: 10.1128/jcm.17.2.349-351.1983 -
Hellenic Journal of Cardiology : HJC =... 2019
Topics: Adrenal Cortex Hormones; Amyloidosis; Antirheumatic Agents; Azathioprine; Colchicine; Heart Failure; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Interleukin 1 Receptor Antagonist Protein; Pericardiectomy; Pericarditis; Quality of Life; Recurrence; Tubulin Modulators
PubMed: 32252971
DOI: 10.1016/j.hjc.2019.12.010 -
Annals of Cardiac Anaesthesia 2017This study was designed to prospectively investigate the effects of pericardiectomy via median sternotomy on intra- and postoperative hemodynamics by a new semi-invasive...
OBJECTIVES
This study was designed to prospectively investigate the effects of pericardiectomy via median sternotomy on intra- and postoperative hemodynamics by a new semi-invasive device (Flotrac/VigileoTM monitor) using arterial pressure waveform analysis.
PATIENTS AND METHODS
Thirty consecutive patients aged 15 to 55 years (mean+SD, 31.73 + 13.53 years), who had undergone total pericardiectomy via median sternotomy underwent serial hemodynamic evaluation. FlotracTM Sensor - derived stroke volume, stroke volume variation, systemic vascular resistance index (SVRI), cardiac index and right atrial pressure were measured just before and after pericardiectomy, at 12 hours, 24 hours, 48 hours, 72 hours and at discharge postoperatively.
RESULTS
Majority of patients (73.33%) exhibited statistically significant reduction of right atrial pressure and SVRI along with improvement in cardiac index and oxygen delivery in the immediate and late postoperative period. However, the stroke volume and stroke volume variation did not increase proportionately on completion of surgery. Patients with low cardiac output syndrome exhibited persistently high central venous pressure with reduced cardiac index and echocardiographically abnormal diastolic filling characteristics.
CONCLUSIONS
We conclude that there is early normalization of hemodynamics following pericardiectomy via median sternotomy and the adequacy of pericardiectomy can be accurately assessed by the new semi-invasive arterial pressure waveform analysis device. Stroke volume variation is a non-predictor of fluid requirement during and after pericardiectomy.
Topics: Adolescent; Adult; Atrial Pressure; Chronic Disease; Female; Follow-Up Studies; Hemodynamics; Humans; Intraoperative Period; Male; Middle Aged; Monitoring, Physiologic; Pericardiectomy; Pericarditis, Constrictive; Postoperative Period; Prospective Studies; Reproducibility of Results; Stroke Volume; Treatment Outcome; Vascular Resistance; Young Adult
PubMed: 28393776
DOI: 10.4103/aca.ACA_98_16 -
CJC Open Jan 2022Mulibrey nanism (MUL) is a rare condition with profound growth delay. Congestive heart failure is a major determinant of prognosis. The aim was to delineate pericardial...
BACKGROUND
Mulibrey nanism (MUL) is a rare condition with profound growth delay. Congestive heart failure is a major determinant of prognosis. The aim was to delineate pericardial constriction and myocardial functional abnormalities in a pediatric MUL sample.
METHODS
A total of 23 MUL patients and 23 individually sex- and age-matched healthy control subjects were prospectively assessed in a cross-sectional study with echocardiography.
RESULTS
Clinical signs of heart failure were present in 7 MUL patients, with severe congestive heart failure in 2. Significant diastolic dysfunction, mainly related to constriction, was found in MUL patients without pericardiectomy (N = 18)-septal bounce, pronounced hepatic vein atrial reversal and right heart inflow-outflow variations, and decreased inferior vena cava collapse during respiration. The appearance of the pericardium was not different from that of control subjects. Longitudinal diastolic myocardial velocities were similar to those in control subjects, suggesting an absence of significant myocardial restriction. Right ventricular free wall longitudinal systolic strain and bilateral longitudinal myocardial systolic velocities were decreased in MUL patients, indicating mild biventricular systolic dysfunction. Myocardial motion abnormalities and persistent congestive heart failure were common (in 3 of 6) in MUL patients with a history of pericardiectomy. Cardiac dimensions were similar between MUL patients and control subjects when adjusting for body size, except for smaller biventricular volumes.
CONCLUSIONS
MUL disease presents with significant constriction-related diastolic dysfunction and mild bilateral systolic dysfunction. Constriction-restriction assessments during follow-up could be of benefit in decision-making regarding pericardiectomy in MUL disease. Myocardial abnormalities were prevalent among MUL patients who had undergone pericardiectomy and are consistent with progression of myocardial disease in a significant proportion of patients.
PubMed: 35072025
DOI: 10.1016/j.cjco.2021.08.012 -
JACC. Case Reports Aug 2021A 65-year-old immunocompromised woman presented with progressive dyspnea and sacroiliac joint pain. Cardiac magnetic resonance showed abnormal right ventricular filling...
A 65-year-old immunocompromised woman presented with progressive dyspnea and sacroiliac joint pain. Cardiac magnetic resonance showed abnormal right ventricular filling with septal bounce and abnormal pericardial enhancement, suggestive of constrictive pericarditis. Cultures from pericardium following pericardiectomy grew . She was diagnosed with coccidioidomycosis and responded to pericardiectomy and amphotericin. ().
PubMed: 34471887
DOI: 10.1016/j.jaccas.2021.04.019 -
Arquivos Brasileiros de Cardiologia May 2023
Topics: Humans; Pericardiectomy; Pericardium; Echocardiography
PubMed: 37341300
DOI: 10.36660/abc.20230290 -
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 -
Cardiovascular Drugs and Therapy Aug 2023Post-pericardiotomy syndrome (PPS) is a common complication of cardiac surgery. This systematic review aimed to investigate the efficacy of colchicine, indomethacin, and... (Review)
Review
PURPOSE
Post-pericardiotomy syndrome (PPS) is a common complication of cardiac surgery. This systematic review aimed to investigate the efficacy of colchicine, indomethacin, and dexamethasone in the treatment and prophylaxis of PPS.
METHODS
Literature research was carried out using PubMed. Studies investigating ≥ 10 patients with clinically PPS treated with colchicine, dexamethasone, and indomethacin and compared with placebo were included. Animal or in vitro experiments, studies on < 10 patients, case reports, congress reports, and review articles were excluded. Cochrane risk-of-bias tool for randomized trials (RoB2) was used for the quality assessment of studies.
RESULTS
Seven studies were included. Among studies with postoperative colchicine treatment, two of them demonstrated a significant reduction of PPS. In the single pre-surgery colchicine administration study, a decrease of PPS cases was registered. Indomethacin pre-surgery administration was linked to a reduction of PPS. No significant result emerged with preoperative dexamethasone intake.
CONCLUSION
Better outcomes have been registered when colchicine and indomethacin were administered as primary prophylactic agents in preventing PPS and PE. Further RCT studies are needed to confirm these results.
Topics: Humans; Pericardiectomy; Postpericardiotomy Syndrome; Cardiac Surgical Procedures; Colchicine; Indomethacin; Dexamethasone
PubMed: 34546452
DOI: 10.1007/s10557-021-07261-4