Subtotal Pericardiectomy via Sternotomy for Constrictive Pericarditis

Abstract

Records of 103 patients with constrictive pericarditis who underwent subtotal pericardiectomy from January 1990 to December 1997 were retrospectively analyzed. The etiology of pericardial constriction was unknown in 63, tuberculous in 30, pyogenic in 7, and miscellaneous in 3 patients. Adequate pericardiectomy could be accomplished in 85 (82.5%) patients. Eleven patients (10.68%) died within 30 days of surgery. The 92 survivors were followed up for 47.21 ± 30.7 months; functional status improved in all cases. Of 15 variables examined by univariate logistic regression analysis, preoperative New York Heart Association functional class IV, atrial fibrillation, left atrial size > 40 mm·m−2, mild to moderate mitral regurgitation, tricuspid regurgitation, pericardial calcification, and inadequate pericardiectomy were found to be significant predictors of poor outcome. Adequate pericardiectomy via sternotomy was considered to carry low operative risk and provide excellent improvement in functional capacity.

Surgical management of constrictive pericarditis

“…6 Other causes of constrictive pericarditis common in developed countries are cardiac surgery, therapeutic irradiation of the mediastinum and trauma. 3,4,5 The ae- tiology of constrictive pericarditis was idiopathic or viral in 46% of cases studied by Stefan et al 1 , and 61% in another study by Ashok et al 7 . In our study, the aetiology of constrictive pericarditis in 36% of the cases was undermined.…”

“…NYHA functional class IV among others was found to be a significant predictor of poor postoperative outcome. 7,15 Delay in surgical treatment makes prognosis worse for patients. Medical management has not been helpful in the management of constrictive pericarditis.…”

Constrictive Pericarditis: Surgical Management

“…This procedure, while curative, is not without notable risks to the patient. Research into prognostic indicators is ongoing, though current recommendations focus on preoperative state and the patient's medical history, Pericardiectomy produces the most positive outcomes in the treatment of constrictive pericarditis when performed early in the disease course [87,88]. Clinical judgment is used to determine which patients are best suited to undergo pericardiectomy.…”

Pericarditis - Diagnosis and Management Challenges [Working Title]

“…In a murine myositis model, 18 F-FDS PET rapidly differentiated infection from sterile inflammation [87]. 18 F-FDS was determined to be safe and well tolerated after a single intravenous dose was injected into healthy human volunteers to assess biodistribution and radiation dosimetry [88].…”