Pericardiectomy: Prompt surgical management of constrictive pericarditis

Abstract

Background: Constrictive pericarditis is a slow progressive fibrosis of the pericardium leading to a variety of symptoms and signs over time. The disease poses a diagnostic challenge; restrictive cardiomyopathy and other syndromes associated with right-sided pressure abnormalities share similar symptoms and clinical findings. Pericardiectomy is considered the treatment of choice for constrictive pericarditis. Here we studied the effects of total radical pericardiectomy on hemodynamics in 37 patients diagnosed with constrictive pericarditis. Methods: Between 2005 and 2012 thirty-seven patients, 31 males and 6 females, age range 15 to 69 years, underwent total pericardiectomy for constrictive pericarditis. Diagnosis was made on the basis of clinical, pathological and diagnostic modalities-ECG, x-rays, magnetic resonance imaging, computed tomography and echocardiogram. The surgical approach was median sternotomy and surgery was conducted without cardiopulmonary bypass. Results: Postoperative outcomes showed overall improvement in the majority of patients. Hemodynamics-stroke volume, cardiac output, ejection fraction, central venous pressure-were all measurably improved postoperatively. There was no postoperative mortality. Conclusion: Radical pericardiectomy is a demonstrably useful procedure for correction of hemodynamic abnormalities and improvement of overall heart function in symptomatic patients with constrictive pericarditis.