Pericardiectomy for constrictive pericarditis with postoperative increase of tricuspid regurgitation

Taguchi, Shinichi; Ishida, Osamu; Mori, Atsuo; Suzuki, Ryo

doi:10.7243/2052-4358-1-9

Cited by 5 publications

(11 citation statements)

References 9 publications

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“…TR worsened after the operation in both groups, but it was aggravated more in the conventional group in the last echocardiography. Several cases of worsening TR or right ventricular dysfunction after pericardiectomy have been reported [23–25]. Mantri et al concluded if an adequate pericardiectomy is done at an earlier stage, the regurgitations will regress [26].…”

Section: Discussionmentioning

confidence: 99%

Long-term results of radical pericardiectomy for constrictive pericarditis in Korean population

Choi

Jeong

et al. 2019

J Cardiothorac Surg

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BackgroundThe 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.MethodsNinety 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.ResultsThe 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.ConclusionsRadical 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.Electronic supplementary materialThe online version of this article (10.1186/s13019-019-0845-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Long-term results of radical pericardiectomy for constrictive pericarditis in Korean population

Choi

Jeong

et al. 2019

J Cardiothorac Surg

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“…11,14 Pericardial calcification can be noticed, which is found on the inferior and diaphragmatic surface in 97%, on the anterior RV surface area in 76%, and on the left atrioventricular groove in 62%. 2,12,13 Magnetic resonance techniques reveal lack of pericardial slippage (adherence). The combination of pericardial non-slippage and ventricular interdependencies suggests constrictive pericarditis.…”

Section: Discussionmentioning

confidence: 99%

“…Predictors of poor outcome after pericardiectomy are New York Heart Association class IV, myocardial fibrosis, underlying malignancy, radiation-induced myocardial inflammation with scarring, and previous pericardial surgery. 2,6,13,14 Of late, an ultrasonic scalpel with a hook-type blade has been utilized for pericardiectomy. With no hyperthermic damage, no myocardial stimulation, minimal strokes, and good hemostasis, pericardiectomy is performed using longitudinal vibration (55,500/s) and cavitational fragmentation that disrupts low-density tissue.…”

Section: Discussionmentioning

confidence: 99%

Constrictive pericarditis: retrospective study of 109 patients

Kumawat

Lahiri

Agarwal

2018

Asian Cardiovasc Thorac Ann

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Background Chronic constrictive pericarditis is the most common diastolic disorder of the heart. Non-elasticity of the pericardium with impaired cardiac diastolic function is constriction. Chronic constrictive pericarditis is the result of scarring and fibrosis in mid and late diastole. The clinical presentation is similar to that of right heart failure. Historically, the etiology is helpful but not diagnostic. Echocardiography and a hemodynamic study are the main diagnostic tools. A thick pericardium of more than 4 mm is not necessarily constrictive, but thickness ≥7 mm is highly specific for constrictive features. Pericardiectomy is usually associated with early normalization of hemodynamics, which can be achieved via a mid-sternotomy or left anterolateral thoracotomy. Methods Data of 109 patients who underwent pericardiectomy from January 1987 to June 2016 were reviewed retrospectively. Results The outcome of our 109 cases consisted of mortality in 2 patients only. Conclusion Progressive, fibrotic, thickened, adherent inflammatory changes in response to various pathologies of the pericardium impairing diastolic filling can be treated by pericardiectomy. Pericardiectomy can be achieved by a mid-sternotomy or anterolateral thoracotomy without any difference in outcome. The initial hemodynamic and clinical result may not always be dramatic but continued improvement is definite because of progressive enlargement of left ventricular dimensions.

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“…There are several case reports of postoperative increase of TR [1,11]. Johnson TL, et al reported two cases of postoperative TR increase in 1993 [11].…”

Section: Increase In Tr Following Operation Without Tricuspid Valve I...mentioning

confidence: 99%

“…In 2013, the author (Taguchi S) published a case of conventional pericardiectomy for constrictive pericarditis [1]. In this case, preoperative mild-moderate tricuspid regurgitation (TR) worsened as severe postoperatively.…”

Section: Introductionmentioning

confidence: 99%

Pericardiectomy and Postoperative Worsening of Tricuspid Regurgitation -Role of Radical Pericardiectomy

Taguchi¹

2022

Cardio Vasc Syst

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Background:In pericardiectomy for constrictive pericarditis, postoperative worsening of tricuspid regurgitation (TR) is a problem to be considered. It is a focus of attention and there are several case reports and studies concerning this phenomenon. Aim: The aim of this review was to examine available literature with regard to worsening of TR after pericardiectomy in order to clarify its incidence, mechanism, long-term outcome, and preventive measures. Results: About one-third to half of patients experience an increase in TR postoperatively without tricuspid valve intervention. Postoperative right ventricular (RV) dilatation, tricuspid annular dilatation, together with perioperative RV dysfunction play the major role. The preoperative existence of TR increased mortality in large studies, and worsened TR postoperatively had a trend toward reduced survival. Whether tricuspid valve intervention improves outcome or not is still to be determined. At least, this intervention appears protective against long-term mortality. Radical pericardiectomy seems to have the possibility to improve the outcome related to TR than conventional pericardiectomy. Conclusions: The findings of this review can be summarized as: 1. In pericardiectomy for constrictive pericarditis, preoperative TR and its postoperative worsening cannot be ignored. 2. Concomitant tricuspid valve intervention has a tendency toward improved long-term survival and should be considered especially in cases with preoperative TR. 3. Regarding TR, radical pericardiectomy seems to have more benefit than conventional pericardiectomy.

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Pericardiectomy for constrictive pericarditis with postoperative increase of tricuspid regurgitation

Cited by 5 publications

References 9 publications

Long-term results of radical pericardiectomy for constrictive pericarditis in Korean population

Long-term results of radical pericardiectomy for constrictive pericarditis in Korean population

Constrictive pericarditis: retrospective study of 109 patients

Pericardiectomy and Postoperative Worsening of Tricuspid Regurgitation -Role of Radical Pericardiectomy

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