Restoration of Normal Intracardiac Pressures after Extensive Pericardiectomy for Constrictive Pericarditis

Abstract

In each of seven patients studied by cardiac catheterization more than 2 weeks after extensive pericardiectomy, performed because of constrictive pericarditis, normal right heart pressure-pulse contours were demonstrated. The extensiveness of pericardial removal seems the most likely explanation for the normal catheterization findings, which contrast with demonstration by other workers of persistence for periods up to 2 years of the "W"-shaped atrial pressures and high end-diastolic ventricular pressures characteristic of pericardial constriction. Clinical findings, abnormal right heart pressures, and surgical considerations are presented for a total of 11 patients with constrictive pericarditis who were subjected to pericardiectomy between 1955 and 1960.

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

“…[25678] Despite the accuracy of thermodilution technique for measuring CO, it is invasive, and there is an unclear risk–benefit ratio. [1617] Recently, less invasive techniques such as transthoracic bioimpedance, pulse dye densitometry, LiDCO system, and PiCCO-system (Paulson SG) have been developed for hemodynamic assessment.…”

“…[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.…”

“…[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. [12345678910]…”

Constrictive pericarditis-induced shunting through a PFO: Persistence despite pericardiectomy

“…However, despite this action, the patient remained hypoxic and post-pericardiectomy imaging showed continued shunting. Most patients who are symptomatic due to constrictive pericarditis (though not necessarily with shunting through PFO) improve rapidly after pericardiectomy [7], [8]; however, some studies have shown that the hemodynamics may remain abnormal for up to several months in certain patients [8]. The reason for this has been related to the degree of surgical success as well as degree of myocardial inflammation and fibrosis [8].…”