Meta-Analysis of Population Characteristics and Outcomes of Patients Undergoing Pericardiectomy for Constrictive Pericarditis

Tzani, Aspasia; Doulamis, Ilias P.; Tzoumas, Andreas; Avgerinos, Dimitrios V.; Koudoumas, Dimitrios; Siasos, Gerasimos; Vavuranakis, Manolis; Klein, Allan L.; Kampaktsis, Polydoros

doi:10.1016/j.amjcard.2021.01.033

Cited by 17 publications

(14 citation statements)

References 25 publications

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“…The effectiveness of treatment with corticosteroids in TP remains controversial. Steroids have not yet been found to have overwhelming beneficial effects on reabsorption of pericardial effusion or in the progression to constrictive pericarditis[ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Tuberculous pericarditis-a silent and challenging disease: A case report

Lucero¹,

Bustos²,

Rodríguez³

et al. 2022

WJCC

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BACKGROUND Tuberculous pericarditis (TP) remains a challenge for endemic countries. In developing countries, one to two percent of patients with pulmonary tuberculosis develops TP. CASE SUMMARY A 49-year-old woman presented with dyspnea, chest pain and dry cough. On physical examination, veiled heart sounds were found. The electrocardiogram showed low-voltage complexes and the transthoracic echocardiography revealed a large and free-looking pericardial effusion. The patient was taken for an open pericardiotomy. The pericardial fluid revealed high levels of adenosine deaminase and Ziehl-Neelsen stain showed acid-fast bacilli. Polymerase chain reaction study for Mycobacterium tuberculosis in pericardial fluid was positive. The patient received tetra conjugate management with adequate clinical response after the first week of treatment and resolution of fever and chest pain. CONCLUSION In cases of TP, obtaining pericardial fluid and/or pericardial biopsy is the most efficient strategy to confirm the diagnosis. Early diagnosis of this entity will allow physicians to initiate timely treatment, avoid complications and improve the patient's clinical outcome, so we consider the description of this case pertinent and its review in the literature.

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Section: Discussionmentioning

confidence: 99%

Tuberculous pericarditis-a silent and challenging disease: A case report

Lucero¹,

Bustos²,

Rodríguez³

et al. 2022

WJCC

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“…However, most of the studies represented single-center and retrospective experiences. Tzani, A. et al performed a meta-analysis to systematically review the clinical outcomes of patients undergoing pericardiectomy for constrictive pericarditis [21]. This meta-analysis included 27 eligible studies and 2,114 patients.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Matrix Metalloprotease 9 On Surgical Outcomes After Pericardiectomy

Fang

et al. 2021

Preprint

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Background The effects of matrix metalloproteases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) expressions on the patients with constrictive pericarditis undergoing pericardiectomy remain unclear. This study explored the associations of MMPs and TIMPs expressions with postoperative outcomes in these patients. Methods Pericardial specimens were obtained during pericardiectomy from the patients with constrictive pericarditis. The levels of MMP1, MMP2, MMP9 and TIMP1 in pericardium were analyzed by quantitative real-time polymerase chain reaction. The enrolled patients were divided into two groups according to the optimal cutoff value of gene expression predicting postoperative complications. Postoperative outcomes were compared between the two groups. Binary logistic regression analysis was performed to determine the degree of contribution of gene expression on postoperative outcomes. Results A total of 22 patients and their pericardial specimens were included. The level of MMP9 was significantly associated with postoperative complications and the optimal cutoff value predicting postoperative complications was 3.67. The patients with low level of MMP9 (< 3.67) had lower incidence of postoperative complications (P = 0.002), shorter postoperative intensive care unit (P = 0.040) and hospital stay (P = 0.043) in comparison to those with high level of MMP9 (≥ 3.67). Binary logistic regression analysis showed that high level of MMP9 increased risk of postoperative complications (OR, 27.096, 95%CI 1.166-629.886, P = 0.040). Conclusions High level of MMP9 in the pericardium was associated with poor postoperative outcomes and was the independent risk factor of postoperative complications. The level of MMP9 could be used as a potential marker for prediction of surgical outcomes.

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“…The mainstay and only treatment available for CP is pericardiectomy. 5 An observational study conducted over a 20-year period on 99 patients in Montreal showed 7.9% hospital mortality for isolated pericardiectomy. Surgical intervention within 6 months of the onset of symptoms was associated with reduced hospital mortality (odds ratio 0.11).…”

Section: Discussionmentioning

confidence: 99%

“…Our patient was not on steroids on admission, which is the most commonly used adjunctive therapy for tuberculous pericarditis. 5 , 8 To date, the largest trial of its use is the ‘investigation of the management of pericarditis trial’ that showed no significant difference in the composite of death, cardiac tamponade requiring pericardiocentesis, or CP between patients who received prednisolone and those who received placebo (23.8% and 24.5%, respectively; hazard ratio 0.95, 95% confidence interval 0.77–1.18; P = 0.66). 9 …”

Section: Discussionmentioning

confidence: 99%

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A case report of tuberculous constrictive pericarditis necessitating total pericardiectomy

Yousif¹,

Alnuwakhtha²,

Darwish³

et al. 2021

European Heart Journal - Case Reports

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Background Constrictive pericarditis (CP) is one of the most serious sequelae of tuberculous pericarditis, which is characterized by heart constriction secondary to intense pericardial inflammation and thickening. Several invasive and non-invasive diagnostic modalities are crucial to address the challenges of confirming the diagnosis of CP and to expedite timely intervention. Case summary This study reports the case of a Bahraini male with tuberculous lymphadenitis diagnosed with CP as a result of various evaluations. The patient underwent urgent total pericardiectomy and showed remarkable recovery with complete resolution of heart failure symptoms. Discussion This case demonstrates the paramount importance of early diagnosis and treatment for patients with CP. In this unique case, the acoustic windows on echocardiography were suboptimal because of pericardial thickening. Further, computed tomography did not show significant calcification of the thickened pericardium. A novel approach of assessing haemodynamics through the right antecubital vein and right radial artery facilitated the accurate diagnosis of CP with confidence. Thereafter, successful pericardiectomy revealed a markedly thickened and stiff pericardium with many abscesses and dense adhesions encasing the heart, and pericardial biopsy showed large caseating granulomas. This case exemplifies the difficulty in diagnosing CP and the favourable outcomes achieved with well-timed surgical intervention.

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Meta-Analysis of Population Characteristics and Outcomes of Patients Undergoing Pericardiectomy for Constrictive Pericarditis

Cited by 17 publications

References 25 publications

Tuberculous pericarditis-a silent and challenging disease: A case report

Tuberculous pericarditis-a silent and challenging disease: A case report

Predictive Value of Matrix Metalloprotease 9 On Surgical Outcomes After Pericardiectomy

A case report of tuberculous constrictive pericarditis necessitating total pericardiectomy

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