Constrictive Pericarditis after Open Heart Surgery: A 20-Year Case Controlled Study

Moreyra, Abel E.; Cosgrove, Nora M.; Zinonos, Stavros; Yang, Yi; Cabrera, Javier; Pepe, Russell J.; Alam, Amit; Kostis, John B.; Lee, Leonard; Kostis, William J.

doi:10.1016/j.ijcard.2020.12.090

Cited by 5 publications

(6 citation statements)

References 25 publications

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“…Due to the small sample size of our study, the relationship between pericarditis and sex still needs to be further explored even after removal of other confounding factors. In previous reports, the time span from surgery to the appearance of PCP varied from 3 weeks to 54 months ( 11 ). Based on the available evidence and reported clinical cases, it is almost impossible to predict the occurrence of PCP and difficult to account for differences in time intervals.…”

Section: Discussionmentioning

confidence: 99%

Early postoperative constrictive pericarditis in China: a single-center retrospective observational study

Peng,

Wang,

Zhong

et al. 2024

J Thorac Dis

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Background The diagnosis, treatment, and prognosis of early postoperative constrictive pericarditis (EPCP) have not been discussed in depth. The objective of this study was to devise and propose a management strategy for EPCP. Methods In this study, constrictive pericarditis (CP) within 6 months after cardiac surgery was defined as EPCP, and patients were divided into two groups based on intraoperative findings: a parietal thickening group and a visceral thickening group. Results A total of 20 patients were included in this study, and the incidence rate of recurrent pericardiectomy was 0.32% among all patients undergoing cardiovascular surgery. EPCP after valve surgery occurred in 85.0% of patients. Pleural effusion was the most common preoperative symptom, occurring in 90% of patients. Pericardial thickening occurred in the visceral layer in seven cases and in the parietal layer in 13 cases. There were no differences in comorbidities, C-reactive protein (CRP) level, or erythrocyte sedimentation rate (ESR) between the two groups. Most patients with visceral thickening (83.3%) needed cardiopulmonary bypass (CPB) assistance during surgery and had a longer hospital stay than those with parietal thickening (52.8±21.8 vs. 34.9±13.8 days, P=0.049). Central venous pressure (CVP) was decreased in all patients after pericardiectomy (24.9±6.96 vs. 8.9±2.92 cmH 2 O, P<0.001), and the cardiac function improved significantly in patients with parietal thickening [New York Heart Association (NYHA) grade ≥ III accounted for 28.6% of patients]. The long-term survival rate of patients with parietal thickening was 92.3% and that of patients with visceral thickening was 57.1%, and there was no significant difference between them (P=0.056). Conclusions Recurrent episodes of chest tightness, pleural effusion, and elevated CVP within 6 months after cardiac surgery should be considered highly suggestive of EPCP. There are few points of difference between pericarditis with thickening of the parietal and visceral layers. After failure of conservative medical treatment, pericardiectomy results in significant improvements in cardiac function and quality of life, especially in patients with thickening of the parietal layer.

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Section: Discussionmentioning

confidence: 99%

Early postoperative constrictive pericarditis in China: a single-center retrospective observational study

Peng,

Wang,

Zhong

et al. 2024

J Thorac Dis

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Section: Discussionmentioning

confidence: 99%

“…[17][18][19] It is worth mentioning that constrictive pericarditis is the most feared long-term complication after pericardial inflammation that may occur several years after cardiac surgery; however, its incidence is extremely rare. 21 Actually, it has been highlighted that, even if the recurrence rate of PPS may be up to 10% to 50%, PPS are usually benign in a short-term follow-up, with a risk of constriction reported to be 1% to 3% in the long term (72 months). 18,[21][22][23] In our population, routine clinical and echocardiographic evaluations after cardiac surgery did not show any signs for constrictive pericarditis.…”

Section: Subclinical Chronic Pps: Clinical Implication and Follow-upmentioning

confidence: 99%

“…21 Actually, it has been highlighted that, even if the recurrence rate of PPS may be up to 10% to 50%, PPS are usually benign in a short-term follow-up, with a risk of constriction reported to be 1% to 3% in the long term (72 months). 18,[21][22][23] In our population, routine clinical and echocardiographic evaluations after cardiac surgery did not show any signs for constrictive pericarditis. Chest pain or new onset of dyspnea were finally associated to clinical diagnoses like myocardial ischemia rather than to pericardial disease.…”

Section: Subclinical Chronic Pps: Clinical Implication and Follow-upmentioning

confidence: 99%

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Prevalence of Pericardial Late Gadolinium Enhancement in Patients After Cardiac Surgery: Clinical and Histological Correlations

Pavon,

Martinez Fernandez,

Arangalage

et al. 2023

Circ: Cardiovascular Imaging

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BACKGROUND: Pericardial late gadolinium enhancement (LGE) is usually associated with active pericarditis, but it is not infrequently found in patients after cardiac surgery even a long time after the intervention. The clinical relevance of this finding and its histological correlates are unknown. We sought to determine the prevalence of chronic pericardial LGE in patients after cardiac surgery. METHODS: All consecutive patients with previous cardiac surgery, who were referred to cardiovascular magnetic resonance between January 2017 and December 2021 were enrolled in the study. Cardiovascular magnetic resonance examination protocol was adapted to clinical indication but always included standard LGE acquisitions. Two independent observers blinded to clinical data assessed the presence of pericardial enhancement on LGE sequences. Fifteen patients underwent cardiac reintervention and pericardial biopsies were obtained. The primary study end point was to assess the prevalence of pericardial enhancement after cardiac surgery and identify possible determinants. The secondary end point was to correlate pericardial enhancement with clinical symptoms and histopathology. RESULTS: Two hundred four patients were included in the study. The median time between surgery and cardiovascular magnetic resonance was 160 months (35–226 months). Pericardial LGE was observed in 90 patients (44%). All patients were asymptomatic, and no specific treatment for pericarditis was started. All patients remained asymptomatic at a 1-year clinical follow-up. Pericardial LGE was significantly correlated with the number of previous surgeries ( P =0.03). Pericardial fibrosis was detected in all 15 pericardial biopsy specimens; pericardial LGE was present in 7 patients (47%) who underwent biopsy. Histological signs of low-grade inflammation were detected in 6 patients (40%) with severe, circumferential pericardial LGE but in no patient without pericardial enhancement. CONCLUSIONS: Pericardial LGE is a frequent finding even several years after cardiac surgery. Its histological correlate is a chronic subclinical post–pericardiotomy inflammation.

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“…Therefore, any patient with a prior history of corrected congenital heart disease, valvular surgeries, coronary artery bypass grafting, or other procedures involving opening of the mediastinum should be evaluated for the development of pericardial thickening or calcification. One twenty-year study found that patients diagnosed with constrictive pericarditis were more likely to have been treated surgically for valvular disease and atrial fibrillation and demonstrated a significantly increased 7-year mortality rate compared to controls [30].…”

Section: Etiology Of Constrictive Pericarditismentioning

confidence: 99%

Constrictive Pericarditis: Surgical Management

Cobb¹,

Pahwa²

2023

Pericarditis - Diagnosis and Management Challenges

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Constrictive pericarditis represents an uncommon sequela of multiple pathologic processes. It involves the pericardium, a tri-layered sac that encases the heart within the mediastinum. Inflammation of the pericardium can lead to formation of fibrous adhesions between the outer wall of this sac and the surface of the heart. Due to the stiff, inflexible structure of the pericardium, its adherence to the heart negatively impacts normal diastolic filling and hemodynamics. Over time, this can lead to reduced cardiac output and severe heart failure. This condition is typically refractory to medical treatment. The definitive treatment of constrictive pericarditis involves surgical decortication and removal of the pericardium to alleviate the constriction and restore normal diastolic filling capacity. This procedure has evolved since its inception and is now the gold standard in curing constrictive pericarditis. However, despite its necessity in the treatment of constrictive pericarditis, this procedure carries considerable risk of intra- and post-operative complications and poor outcomes. The poor prognosis is often related to the patient’s pre-surgical status, which must be considered when identifying candidates for surgery. When successful, though, pericardiectomy can produce immediate and progressive improvements in hemodynamic parameters.

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Constrictive Pericarditis after Open Heart Surgery: A 20-Year Case Controlled Study

Cited by 5 publications

References 25 publications

Early postoperative constrictive pericarditis in China: a single-center retrospective observational study

Early postoperative constrictive pericarditis in China: a single-center retrospective observational study

Prevalence of Pericardial Late Gadolinium Enhancement in Patients After Cardiac Surgery: Clinical and Histological Correlations

Constrictive Pericarditis: Surgical Management

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