TEE as a monitor during pericardiectomy for constrictive pericarditis

Abstract

Constrictive pericarditis (CP) is a chronic condition where pericardium gets thickened, fibrosed, and calcified, thereby restricting the filling of the ventricles. Surgical removal of the pericardium is the best effective treatment for CP. Because of the advent of newer and better antibiotics, the need for surgical pericardiectomy has declined at least in the developing countries [1]. Nevertheless, malignancy and radiation induced CP is not that uncommon. Pericardiectomy can be either radical or subtotal depending upon the extent of release of adhered pericardium. It can be done via midline sternotomy or anterolateral thoracotomy either on bypass or off bypass. Each technique has got its own merits and demerits. Two main factors determining the clinical and hemodynamic improvement after surgery are the extent of adequate resection and status of the underlying ventricles. Adequate resection is said to be achieved when both ventricles, atrioventricular grooves, and the bases of the great vessels are freed of the disease process [2]. The adequacy of resection intraoperatively is generally monitored by the fall in the baseline central venous pressures and rarely by the improvement in the voltages of electrocardiogram (ECG) complexes. However, these monitors are not without drawbacks. The central venous pressure monitored by the internal jugular vein (IJV) catheter is influenced by many factors like patient position, volume status, inotrope therapy, anesthetic drugs, and usage of chest retractors. ECG monitor also has got inherent drawbacks like being less sensitive, prone for cautery disturbances, and poor signals owing to loss of contact of electrodes because of the disinfectants used for cleaning, whereas

Pulmonary Artery Perforation: Rare reported Complication of Pericardiectomy for Chronic Constrictive Pericarditis recorded on Transesophageal Echocardiography

“…This can be easily detected as regional wall motion abnormality on TEE. 4 In addition, with pericardiectomy the collapsibility of inferior venae cava improves, which can be confirmed on TEE. This can be correlated with concomitant fall in central venous pressures.…”

“…Transesophageal echocardiography is also an important monitoring tool to confirm the adequacy of resection during pericardiectomy for constrictive pericarditis. 4 The resection is considered adequate when both ventricles, atrioventricular grooves, and the bases of great vessels are free of thickened pericardium. 5 The pericardium in CCP is thickened, fibrosed, calcified, and echogenic and can be easily appreciated on TEE.…”

“…Thus, any leftover thickened pericardium in the least accessible areas can be detected on TEE, thus guiding the surgeon to dissect pericardium in these areas. 4 Also, the exaggerated respirophasic variations in transmitral blood flow velocities that occur in constrictive pericarditis are normalized following a complete pericardiectomy. 6 After successful pericardiectomy, the improvement in ventricular filling can be appreciated on TEE.…”