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Clinical Cardiology May 1999The diagnosis of constrictive pericarditis remains a challenge because its physical findings and hemodynamics mimic restrictive cardiomyopathy. Various diagnostic... (Review)
Review
The diagnosis of constrictive pericarditis remains a challenge because its physical findings and hemodynamics mimic restrictive cardiomyopathy. Various diagnostic advances over the years enable us to differentiate between these two conditions. This review begins with a case report of constrictive pericarditis, followed by a brief history and discussions of etiologies. Clinical features, radiologic, electrocardiographic, angiographic findings, and hemodynamics of constrictive pericarditis are reviewed. The echocardiographic findings are detailed and the recent advances in Doppler flow velocity patterns of pulmonary, mitral, tricuspid valves and hepatic veins are reported. Nuclear ventriculograms depict rapid ventricular filling in constrictive pericarditis and differentiate it from restrictive cardiomyopathy. Endomyocardial biopsy helps further in recognizing the various types of restrictive cardiomyopathies. Computed tomography and magnetic resonance imaging delineate abnormal pericardial thickness in constrictive pericarditis. Association of characteristic hemodynamic changes and abnormal pericardial thickness > 3 mm usually confirms the diagnosis of constrictive pericarditis. Effusive and occult varieties of constrictive pericarditis are briefly described. This review concludes with emphasizing the importance of pericardial resection.
Topics: Adult; Echocardiography, Doppler, Color; Electrocardiography; Hemodynamics; Humans; Magnetic Resonance Imaging; Male; Pericardiectomy; Pericarditis, Constrictive; Radiography, Thoracic; Tomography, X-Ray Computed
PubMed: 10326166
DOI: 10.1002/clc.4960220509 -
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 -
Thorax Feb 1978Forty-one patients with acute tuberculous pericarditis were studied retrospectively. Anti-tuberculosis chemotherapy alone was effective in thirty. Five patients died,... (Comparative Study)
Comparative Study
Forty-one patients with acute tuberculous pericarditis were studied retrospectively. Anti-tuberculosis chemotherapy alone was effective in thirty. Five patients died, two from unrelated causes, two due to delayed diagnosis, and one after pericardiectomy. Constrictive pericarditis developed in seven patients, six of whom had successful pericardiectomy. Corticosteroids could not be shown to have reduced the risk of developing constriction. When constriction occurred it did so within the first six months of illness in all cases in contrast to a separate series of 15 patients who presented with constrictive pericarditis. These had had no previous history of tuberculosis, and in 10 cases where pericardiectomy was done, no histological evidence of tuberculosis was found. They were European with an average age of 49 years whereas in the group with acute tuberculous pericarditis 33 were Asian and the average age was 36 years.
Topics: Acute Disease; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Asia; Drug Therapy, Combination; England; Female; Humans; Male; Middle Aged; Pericarditis, Constrictive; Pericarditis, Tuberculous; Retrospective Studies; Tuberculosis, Cardiovascular
PubMed: 644546
DOI: 10.1136/thx.33.1.94 -
The Journal of Thoracic and... May 2015
Topics: Female; Humans; Male; Pericardiectomy; Postpericardiotomy Syndrome
PubMed: 25769776
DOI: 10.1016/j.jtcvs.2015.02.009 -
Cureus Oct 2020The most common cause of ascites is liver cirrhosis. Additional causes such as heart failure, cancer, and pancreatitis among others can also precipitate this...
The most common cause of ascites is liver cirrhosis. Additional causes such as heart failure, cancer, and pancreatitis among others can also precipitate this abnormality. Spontaneous bacterial peritonitis (SBP) is an infection of ascitic fluid that happens without any evidence of an intra-abdominal surgically-treatable cause. Ascites of cardiac origin can also be complicated by SBP. Here we present a case of a 62-year-old male with extensive cardiac history who presented to our service with ongoing dyspnea and orthopnea. He also had significant abdominal distention and pitting edema. The patient was found to have constrictive pericarditis and was admitted for pericardiectomy. Ascitic fluid was consistent with a transudative process. Lab and imaging did not show evidence of liver or kidney disease. Ascitic fluid was indicative of ascites of cardiac origin. Postoperatively patient developed intermittent fevers initially thought to be due to pericarditis but later found to be due to SBP complicating his recurrent ascites. Such a temporal association of SBP that complicates ascites after pericardiectomy has not been discussed frequently in literature.
PubMed: 33209551
DOI: 10.7759/cureus.10995 -
The Journal of Thoracic and... Feb 2016
Topics: Adipose Tissue; Decompression, Surgical; Female; Heart Diseases; Humans; Lipomatosis; Pericardiectomy; Pericardium
PubMed: 26578183
DOI: 10.1016/j.jtcvs.2015.10.050 -
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 -
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 -
The Cochrane Database of Systematic... Jan 2013Atrial fibrillation is a common post-operative complication of cardiac surgery and is associated with an increased risk of post-operative stroke, increased length of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Atrial fibrillation is a common post-operative complication of cardiac surgery and is associated with an increased risk of post-operative stroke, increased length of intensive care unit and hospital stays, healthcare costs and mortality. Numerous trials have evaluated various pharmacological and non-pharmacological prophylactic interventions for their efficacy in preventing post-operative atrial fibrillation. We conducted an update to a 2004 Cochrane systematic review and meta-analysis of the literature to gain a better understanding of the effectiveness of these interventions.
OBJECTIVES
The primary objective was to assess the effects of pharmacological and non-pharmacological interventions for preventing post-operative atrial fibrillation or supraventricular tachycardia after cardiac surgery. Secondary objectives were to determine the effects on post-operative stroke or cerebrovascular accident, mortality, cardiovascular mortality, length of hospital stay and cost of treatment during the hospital stay.
SEARCH METHODS
We searched the Cochrane Central Register of ControlLed Trials (CENTRAL) (Issue 8, 2011), MEDLINE (from 1946 to July 2011), EMBASE (from 1974 to July 2011) and CINAHL (from 1981 to July 2011).
SELECTION CRITERIA
We selected randomized controlled trials (RCTs) that included adult patients undergoing cardiac surgery who were allocated to pharmacological or non-pharmacological interventions for the prevention of post-operative atrial fibrillation or supraventricular tachycardia, except digoxin, potassium (K(+)), or steroids.
DATA COLLECTION AND ANALYSIS
Two review authors independently abstracted study data and assessed trial quality.
MAIN RESULTS
One hundred and eighteen studies with 138 treatment groups and 17,364 participants were included in this review. Fifty-seven of these studies were included in the original version of this review while 61 were added, including 27 on interventions that were not considered in the original version. Interventions included amiodarone, beta-blockers, sotalol, magnesium, atrial pacing and posterior pericardiotomy. Each of the studied interventions significantly reduced the rate of post-operative atrial fibrillation after cardiac surgery compared with a control. Beta-blockers (odds ratio (OR) 0.33; 95% confidence interval) CI 0.26 to 0.43; I(2) = 55%) and sotalol (OR 0.34; 95% CI 0.26 to 0.43; I(2) = 3%) appear to have similar efficacy while magnesium's efficacy (OR 0.55; 95% CI 0.41 to 0.73; I(2) = 51%) may be slightly less. Amiodarone (OR 0.43; 95% CI 0.34 to 0.54; I(2) = 63%), atrial pacing (OR 0.47; 95% CI 0.36 to 0.61; I(2) = 50%) and posterior pericardiotomy (OR 0.35; 95% CI 0.18 to 0.67; I(2) = 66%) were all found to be effective. Prophylactic intervention decreased the hospital length of stay by approximately two-thirds of a day and decreased the cost of hospital treatment by roughly $1250 US. Intervention was also found to reduce the odds of post-operative stroke, though this reduction did not reach statistical significance (OR 0.69; 95% CI 0.47 to 1.01; I(2) = 0%). No significant effect on all-cause or cardiovascular mortality was demonstrated.
AUTHORS' CONCLUSIONS
Prophylaxis to prevent atrial fibrillation after cardiac surgery with any of the studied pharmacological or non-pharmacological interventions may be favored because of its reduction in the rate of atrial fibrillation, decrease in the length of stay and cost of hospital treatment and a possible decrease in the rate of stroke. However, this review is limited by the quality of the available data and heterogeneity between the included studies. Selection of appropriate interventions may depend on the individual patient situation and should take into consideration adverse effects and the cost associated with each approach.
Topics: Adrenergic beta-Antagonists; Adult; Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Cardiac Pacing, Artificial; Cardiac Surgical Procedures; Humans; Magnesium Compounds; Pericardiectomy; Randomized Controlled Trials as Topic; Sotalol; Tachycardia, Supraventricular
PubMed: 23440790
DOI: 10.1002/14651858.CD003611.pub3 -
Journal of Cardiothoracic Surgery Feb 2019The extent of pericardiectomy is an important issue in constrictive pericarditis but its impact on long-term outcomes has been rarely reported. We compared long-term... (Comparative Study)
Comparative Study
BACKGROUND
The extent of pericardiectomy is an important issue in constrictive pericarditis but its impact on long-term outcomes has been rarely reported. We compared long-term results of radical pericardiectomy with conventional phrenic to phrenic pericardiectomy.
METHODS
Ninety patients who underwent pericardiectomies between February 1995 and April 2015 were reviewed retrospectively. They were classified into conventional (n = 37) and radical (n = 53) groups according to pericardiectomy being performed anterior or posterior to the phrenic nerves, respectively. The follow-up duration at outpatient clinic was 37.6 (11.7, 86.6) months and the survival data until 91.6 (54.5, 147.0) months were obtained. The last echocardiographies were done at 22.4 (4.35, 60.85) months.
RESULTS
The early mortality rate was 4.4% (4/90). They all belonged to the conventional group and died of low cardiac output syndrome. The survival rate was higher in the radical group (P = .032, 74.7 ± 9.2% versus 50.4 ± 11.9% in 20 years). NYHA class of both groups had recovered until the last follow-up but the radical group showed better recovery (P < .001). The conventional pericardiectomy (HR = 6.181; 95% CI (1.042, 36.656)), redosternotomy (HR = 6.441; 95% CI (1.224, 33.889) and preoperative grade of tricuspid regurgitation (HR = 15.003; 95% CI (1.099, 204.894) were associated with late mortality. Right ventricular systolic pressure decreased, and pericardial thickening resolved only in the radical group with significant intergroup differences as time went on. Tricuspid regurgitation worsened after the operation in both groups, but it deteriorated more in the conventional group. However, it improved over time in the radical group.
CONCLUSIONS
Radical pericardiectomy led to greater improvement in right ventricular systolic pressure and lesser deterioration of tricuspid regurgitation with the passage of time than did the conventional procedure. Conventional pericardiectomy and preoperative higher grade tricuspid regurgitation were associated with long-term mortality.
Topics: Adult; Aged; Blood Pressure; Echocardiography; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pericardiectomy; Pericarditis, Constrictive; Pericardium; Republic of Korea; Retrospective Studies; Survival Rate; Systole; Time Factors; Tricuspid Valve Insufficiency; Ventricular Function, Right
PubMed: 30728044
DOI: 10.1186/s13019-019-0845-7