Hemodynamic Studies Following Pericardiectomy for Constrictive Pericarditis

Abstract

Fourteen patients underwent right heart catheterization 5 to 86 months after pericardiectomy for constrictive pericarditis. Twelve had preoperative catheterizations, all with findings typical of constrictive pericarditis. All patients showed marked hemodynamic and symptomatic improvement after operation. Three patients had persistent mild elevation of right heart and pulmonary artery pressures; one of these had a low cardiac output. Two other patients developed pulmonary hypertension with exercise, and one man showed an inadequate increase in cardiac output with exercise. Twelve patients were asymptomatic postoperatively and two had exertional dyspnea. Patients with incomplete pericardiectomy over the ventricles had abnormal hemodynamic results, while decortication of the atria and venae cavae made no difference in the postoperative findings. A left anterolateral thoracotomy incision provided adequate exposure for pericardiectomy, and continues to be the incision of choice at this hospital. Younger patients and those who progressed from recognized acute pericarditis to pericardial constriction more frequently had normal results at cardiac catheterization after operation. Certain preoperative liver-function tests correlated well with the postoperative hemodynamic findings. The role of myocardial disease in producing residual hemodynamic abnormalities remains unresolved. It is concluded that excellent clinical results and normal hemodynamic findings can be achieved by pericardiectomy in most patients with constrictive pericarditis.

Surgical experience with chronic constrictive pericarditis

“…Other smaller excisions with more limited scope are considered to be partial. The extent of pericardiectomy needed for constrictive pericarditis has been discussed [3][4][10][11]. The point at discussion is the T. necessity of decortication of the right atrium and the vena cava.…”

“…Pericardiectomy for constrictive pericarditis was first successfully performed and described by Rehn et al [1] and has become the accepted definitive method of treatment for improving cardiac hemodynamics [2][3].…”

Anesthesia and the patient with pericardial disease

“…[73][74][75] Indeed, Senni et al reported diastolic followup in 58 patients following pericardiotomy for CP. 76 Early (within 14 days of surgery) Doppler follow-up demonstrated persistent diastolic abnormalities in up to 60% of these patients.…”

Serial semi-invasive hemodynamic assessment following pericardiectomy for chronic constrictive pericarditis

“…[1234] Nevertheless, some patients fail to improve after pericardiectomy. [567] In our previous study on 395 patients undergoing pericardiectomy between 1985 and 2004, we had demonstrated that total pericardiectomy is associated with lower mortality, less postoperative low cardiac output (CO) syndrome, early normalization of hemodynamics, and better long-term survival compared with partial pericardiectomy. In patients with constrictive pericarditis, this is more easily approached through median sternotomy.…”

“…[15678] Moreover, the data obtained and conclusions reached have varied considerably, from the demonstration of normal findings[1256] to the conclusion that restitution of normal cardiac function seldom occurs. [7] The postoperative evaluation of these patients has been complicated by disparate opinions regarding the proper incision for optimal surgical exposure and the extent of decortication necessary for adequate cardiac decompression.…”