Details are presented which relate to a patient in whom constrictive pericarditis developed during pregnancy. Successful pericardiectomy was performed at 24 weeks' gestation and a normal infant was delivered at term. The results of medical and surgical treatment of cardiac patients during pregnancy, the results of pericardiectomy, and the risk to the foetus are discussed. (Ueland, 1965), and correction of these lesions has therefore been the type of operation most commonly undertaken.Constrictive pericarditis is a common lesion in those parts of the world where tuberculosis is uncontrolled. Many patients with tuberculosis are infertile, so that the occurrence of pregnancy in patients with constrictive pericarditis is relatively rare. The purpose of this paper is to report the details which relate to a patient in whom pericardiectomy was undertaken in pregnancy.third heart sound. The liver was palpable 9 cm. below the right costal margin, and the spleen 1 cm. below the left. The fundus of the uterus was felt 3 cm. below the umbilicus, consistent with the twenty-fourth week of pregnancy. Foetal heart sounds were normal.Laboratory investigations showed a haemoglobin of 10 5 g. / 100 ml.; a white cell count of 6,000 per cu. mm.; an erythrocyte sedimentation rate of 51 mm.in the first hour; and a blood urea of 18 mg./O00 ml.A tuberculin test was positive.The electrocardiogram (Fig. 1) showed sinus tachycardia, at a rate of 125 per minute, and a mean frontal QRS axis of +10°. low voltage in the standard leads and generalized ST-T wave depression or inversion. The chest radiograph (Fig. 2) showed bilateral pleural effusions, a heart shadow with a -J~~AA.m-
(1978). Thorax, 33,[608][609][610][611]. Valve replacement for rheumatic aortic incompetence in adolescents. The timing of valve replacement in patients with rheumatic aortic regurgitation is assessed by balancing the mortality and complications associated with the operation and the prosthetic valves against the natural history of the lesion. The time course without surgery is determined by the severity of the volume overload and the gradual deterioration of myocardial function. We wished to obtain information both on the haemodynamic recovery achieved after aortic valve replacement in young patients and also on the risks of operation in this group. Twenty patients, in whom the aortic valve was replaced at a mean age of 15 years, were reviewed. An improvement in symptoms and in the cardiothoracic ratio on the chest radiograph occurred in every case, and the voltage measurements suggestive of left ventricular hypertrophy on electrocardiogram diminished in all but two. The left ventricular end-diastolic pressure decreased in the 11 patients who were recatheterised after operation. The ejection fraction improved in three patients and stayed the same in three others. While there were no operative deaths in our series the incidence of serious morbidity, in terms of myocardial damage at or after operation, was disappointingly high. Early valve replacement to preserve myocardial function is especially attractive in young patients but cannot be advised if the insertion of the prosthetic valve is associated with appreciable myocardial damage.
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