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Duarte NF, de Aguiar Trigueirinho Ferreira S, Filho DAA, Vidal CHL, Lima RS, Martins AVV, Castro RO, de Assis ACR, Soares PR, Scudeler TL. Right ventricular dysfunction after pericardiectomy for tuberculous constrictive pericarditis: A case report. Clin Case Rep 2024; 12:e8899. [PMID: 38799540 PMCID: PMC11116479 DOI: 10.1002/ccr3.8899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 04/22/2024] [Accepted: 04/28/2024] [Indexed: 05/29/2024] Open
Abstract
Key Clinical MessageThis case report provides a peculiar case of tuberculous constrictive pericarditis (TCP) who presented with right ventricular dysfunction after pericardiectomy. Right ventricular dysfunction is one of the main postoperative complications after pericardiectomy. Rapid and accurate identification of right ventricular dysfunction confirmed by transthoracic echocardiography (TTE), associated with the rapid initiation of diuretics and inotropic therapy is necessary for the patient's complete recovery.AbstractTCP is a condition characterized by chronic inflammation and fibrosis of the pericardium. Pericardiectomy is the standard treatment for patients with constrictive pericarditis and persistent symptoms. One possible surgical complication is right ventricle (RV) failure. We report a case of a 44‐year‐old man who developed RV failure after pericardiectomy for TCP. A 41‐year‐old man with no medical history was referred to our hospital due to progressive dyspnea associated with edema of the lower limbs and significant weight loss (30 kg) over the past 5 months. TTE revealed significant pericardial thickening and mild pericardial effusion with normal RV function. Chest X‐ray showed moderate bilateral pleural effusion. The patient underwent pericardiectomy and bilateral pleural drainage. Histopathological examination showed tuberculosis granulomas with caseous necrosis, and antituberculosis medication was initiated. Postoperative TTEs showed normal RV function and mild pericardial thickening. The patient was discharged home after successful postoperative recovery. Three weeks later, the patient was admitted to the emergency department with dyspnea and hypoxemia. TTE revealed RV systolic dysfunction. Chest CT showed a recurrence of moderate pleural effusion, this time loculated, with restrictive atelectasis of the adjacent lung parenchyma. Diuretics and inotropic therapy were initiated, and the patient underwent lung decortication after confirmation of tuberculous empyema. The patient experienced significant clinical improvement. TTE before discharge showed a decreased RV chamber size with improved RV systolic function. The patient was discharged in a stable condition 30 days after admission with a low dose of oral furosemide. Four months after discharge, he remained asymptomatic with good functional status. Pericardiectomy for TCP may carry the risk of developing RV dysfunction. Furthermore, TCP itself may be associated with other complications, such as empyema. We emphasize the importance of conducting a thorough clinical evaluation for patients with TCP, particularly those undergoing pericardiectomy, to mitigate potential adverse outcomes.
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Affiliation(s)
- Natânia Ferreira Duarte
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | | | - Daniel Abdalla Added Filho
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Carlos Henrique Lopes Vidal
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Roger Sales Lima
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Ana Vitória Vitoreti Martins
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Rafael Oliveira Castro
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Arthur Cicupira Rodrigues de Assis
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Paulo Rogério Soares
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Thiago Luis Scudeler
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
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Zochios V, Shelley B, Antonini MV, Chawla S, Sato R, Dugar S, Valchanov K, Roscoe A, Scott J, Bangash MN, Akhtar W, Rosenberg A, Dimarakis I, Khorsandi M, Yusuff H. Mechanisms of Acute Right Ventricular Injury in Cardiothoracic Surgical and Critical Care Settings: Part 1. J Cardiothorac Vasc Anesth 2023; 37:2073-2086. [PMID: 37393133 DOI: 10.1053/j.jvca.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/21/2023] [Accepted: 06/07/2023] [Indexed: 07/03/2023]
Affiliation(s)
- Vasileios Zochios
- Department of Cardiothoracic Critical Care Medicine and ECMO Unit, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.
| | - Benjamin Shelley
- Department of Cardiothoracic Anesthesia and Intensive Care, Golden Jubilee National Hospital, Clydebank, United Kingdom; Anesthesia, Perioperative Medicine and Critical Care research group, University of Glasgow, Glasgow, United Kingdom
| | - Marta Velia Antonini
- Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy; Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Sanchit Chawla
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Ryota Sato
- Division of Critical Care Medicine, Department of Medicine, The Queen's Medical Center, Honolulu, HI
| | - Siddharth Dugar
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH; Cleveland Clinic Lerner College of Medicine, Case Western University Reserve University, Cleveland, OH
| | - Kamen Valchanov
- Department of Anesthesia and Perioperative Medicine, Singapore General Hospital, Singapore
| | - Andrew Roscoe
- Department of Anesthesia and Perioperative Medicine, Singapore General Hospital, Singapore; Department of Anesthesiology, Singapore General Hospital, National Heart Center, Singapore
| | - Jeffrey Scott
- Jackson Health System, Miami Transplant Institute, Miami, FL
| | - Mansoor N Bangash
- Liver Intensive Care Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom; Birmingham Liver Failure Research Group, Institute of Inflammation and Ageing, College of Medical and Dental sciences, University of Birmingham, Birmingham, United Kingdom; Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, College of Medical and Dental sciences, University of Birmingham, Birmingham, United Kingdom
| | - Waqas Akhtar
- Royal Brompton and Harefield Hospitals, Part of Guys and St. Thomas's National Health System Foundation Trust, London, United Kingdom
| | - Alex Rosenberg
- Royal Brompton and Harefield Hospitals, Part of Guys and St. Thomas's National Health System Foundation Trust, London, United Kingdom
| | - Ioannis Dimarakis
- Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, WA
| | - Maziar Khorsandi
- Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, WA
| | - Hakeem Yusuff
- Department of Cardiothoracic Critical Care Medicine and ECMO Unit, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
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Sato M, Kato T, Ito M, Watanabe Y, Ito J, Takamura C, Terashima M. Transverse and longitudinal right ventricular fractional parameters derived from four-chamber cine MRI are associated with right ventricular dysfunction etiology. Sci Rep 2023; 13:5229. [PMID: 36997599 PMCID: PMC10063639 DOI: 10.1038/s41598-023-32284-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/25/2023] [Indexed: 04/01/2023] Open
Abstract
Studies of the usefulness of transverse right ventricular (RV) shortening are limited. We retrospectively analyzed the CMR images of 67 patients (age: 50.8 ± 19.0 years; men: 53.7%; Control: n = 20, Overloaded RV (atrial septal defect): n = 15, Constricted RV (pericarditis): n = 17, Degenerated RV (arrhythmogenic right ventricular cardiomyopathy): n = 15) (all enrolled consecutively for each disease) in a single center. We defined RV longitudinal (fractional longitudinal change: FLC) and transverse (fractional transverse change: FTC) contraction parameters. We assessed the FTC/FLC (T/L) ratio on four-chamber cine CMR views and compared the four groups regarding the fractional parameters. FTC had a stronger correlation (R2 = 0.650; p < 0.001) with RV ejection fraction than that with FLC (R2 = 0.211; p < 0.001) in the linear regression analysis. Both FLC and FTC were significantly lower in the Degenerated RV and Constricted RV groups compared with those in the Control and Overloaded RV groups. The T/L ratio was significantly lower in the Degenerated RV group (p = 0.008), while the Overloaded RV (p = 0.986) and Constricted RV (p = 0.582) groups had preserved T/L ratios, compared with the Control group. Transverse shortening contributes to RV function more significantly compared with longitudinal contraction. Impaired T/L ratios may reflect RV myocardial degeneration. RV fractional parameters may help precisely understand RV dysfunction.
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Affiliation(s)
- Makito Sato
- Cardiovascular Imaging Clinic Iidabashi, Shin-Ogawamachi 1-14, Shinjuku-ku, Tokyo, 162-0814, Japan.
| | - Tomoko Kato
- Department of Cardiology, International University of Health and Welfare Narita Hospital, Chiba, 286-8520, Japan
| | - Miyuki Ito
- Cardiovascular Imaging Clinic Iidabashi, Shin-Ogawamachi 1-14, Shinjuku-ku, Tokyo, 162-0814, Japan
| | - Yoko Watanabe
- Cardiovascular Imaging Clinic Iidabashi, Shin-Ogawamachi 1-14, Shinjuku-ku, Tokyo, 162-0814, Japan
| | - Junko Ito
- Cardiovascular Imaging Clinic Iidabashi, Shin-Ogawamachi 1-14, Shinjuku-ku, Tokyo, 162-0814, Japan
| | - Chisato Takamura
- Cardiovascular Imaging Clinic Iidabashi, Shin-Ogawamachi 1-14, Shinjuku-ku, Tokyo, 162-0814, Japan
| | - Masahiro Terashima
- Cardiovascular Imaging Clinic Iidabashi, Shin-Ogawamachi 1-14, Shinjuku-ku, Tokyo, 162-0814, Japan
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Chung JS, Bylsma R, Denham LJ, Hu H, Mamdani N, Bharadwaj A, Rabkin DG. Hemorrhagic pericardial effusion resulting in constriction in hereditary hemorrhagic telangiectasia. J Cardiothorac Surg 2022; 17:44. [PMID: 35313923 PMCID: PMC8935106 DOI: 10.1186/s13019-022-01782-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 03/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background We report the first ante-mortem diagnosis of hemorrhagic pericardial effusion in hereditary hemorrhagic telangiectasia resulting in constriction; the case also demonstrates the unusual but well-described complication of right-sided heart failure requiring extracorporeal membrane oxygenation (ECMO) support after pericardiectomy.
Case presentation A previously healthy 48 year old man with a strong family history of Osler–Weber–Rendu disease presented to our institution with signs and symptoms of advance heart failure. His workup demonstrated a thickened pericardium and constrictive physiology. He was brought to the operating room where old clot and inflamed tissue were appreciated in the pericardial space and he underwent complete pericardiectomy under cardiopulmonary bypass. Separation from bypass, hampered by the development of right ventricular dysfunction and profound vasoplegia, required significant pressor and inotropic support. The right heart dysfunction and vasoplegia worsened in the early postoperative period requiring a week of ECMO after which his right ventricle recovered and he was successfully de-cannulated. Conclusion Given the poor outcome of severe postoperative right ventricular failure after pericardiectomy, with high central venous pressure, a low gradient between central venous and pulmonary artery pressures and high vasopressor requirements, ECMO should be instituted promptly.
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Gonzalez C, Chamberland ME, Aldred MP, Couture E, Beaubien-Souligny W, Calderone A, Lamarche Y, Denault A. Constrictive pericarditis: portal, splenic, and femoral venous Doppler pulsatility: a case series. Can J Anaesth 2021; 69:119-128. [PMID: 34739707 DOI: 10.1007/s12630-021-02126-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/12/2021] [Accepted: 09/09/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Pulsatile flow of the portal vein has been implicated as an indicator of right ventricular dysfunction in cardiac patients. In patients with significantly elevated right atrial pressure, pulsatile venous flow may be transmitted to the portal, splenic, renal, and femoral veins. We describe the evolution of these echocardiographic findings in four patients with constrictive pericarditis (CP) undergoing pericardiectomy with simultaneous hemodynamic waveform and cerebral oximetry monitoring in the operating room and in the intensive care unit. CLINICAL FEATURES Patient 1 presented classic signs of CP, including equalization of left and right diastolic pressures, a "square root" sign on the diastolic portion of the right ventricular pressure curve, and elevated right atrial pressure. Preoperative transesophageal echocardiography showed a hyperdynamic left ventricle and dilated right ventricle with abnormal pulsatile waveforms in the portal and splenic veins. Surgical decompression of the pericardium gradually normalized the Doppler waveforms. Increased venous return following pericardiectomy during surgery in patients 2 and 3 and during the postoperative period in patient 4 resulted in right ventricular (RV) failure due to significantly increased preload. Venous pulsatility was also observed in the portal, splenic, and femoral veins. CONCLUSION In patients with CP, changes in hemodynamic and echocardiographic signs of RV dysfunction are rapidly reflected by changes in peripheral venous velocities. Identifying signs of splanchnic and peripheral vascular venous congestion could help identify patients at higher risk of developing postoperative complications following pericardiectomy.
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Affiliation(s)
- Céline Gonzalez
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Marie-Eve Chamberland
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Matthew P Aldred
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Etienne Couture
- Department of Anesthesiology and Department of Medicine, Division of Intensive Care Medicine, Institut Universitaire de Cardiologie et de Pneumologie, Quebec, QC, Canada
| | - William Beaubien-Souligny
- Department of Medicine, Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Alexander Calderone
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Yoan Lamarche
- Department of Cardiac Surgery and Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - André Denault
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada. .,Department of Anesthesiology and Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada.
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Azzu A, Morosin M, Antonopoulos AS, Capoccia M, Rosendahl U, Mohiaddin R. Cardiac Decompression by Pericardiectomy for Constrictive Pericarditis: Multimodality Imaging to Identify Patients at Risk for Prolonged Inotropic Support. J Cardiovasc Imaging 2021; 29:361-372. [PMID: 34080350 PMCID: PMC8592688 DOI: 10.4250/jcvi.2020.0223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/27/2021] [Accepted: 04/05/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Post-pericardiectomy right ventricular (RV) failure has been reported but it remains not well-studied. To investigate imaging parameters that could predict RV function and the outcome of patients post-pericardiectomy. METHODS We analysed data from a total of 53 CP patients undergoing pericardiectomy. Preoperative, early and at 6 months postoperative echocardiographic (echo) imaging datasets were analysed and correlated with preoperative cardiac magnetic resonance (CMR), cardiac computed tomography scans and histology. The primary endpoint of the study was RV functional status early postoperatively and at 6 months. Secondary endpoint was the need for prolonged inotropic support. RESULTS A cause of CP was identified in 26 patients (49%). Inotropic support ≥ 48 hours was required in n = 28 (53%) of patients and was correlated with lower preoperative RV areas by echo or RV volumes by CMR (p < 0.05 for all). A pericardial score based on pericardial thickness/calcification and epicardial fat thickness had good diagnostic accuracy to identify patients requiring prolonged use of inotropes (area under the curve, 0.825; 95% confidence interval, 0.674–0.976). Pericardiectomy resulted in RV decompression and impaired RV function early postoperatively (fractional area change: 40.5% ± 8.8% preoperatively vs. 31.4% ± 10.4% early postoperatively vs. 42.5% ± 10.2% at 6 months, p < 0.001). CONCLUSIONS We show that a smaller RV cavity size and a pericardial scoring system are associated with prolonged inotropic support in CP patients undergoing pericardiectomy. RV systolic impairment post decompression is present in most patients, but it is only transient.
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Affiliation(s)
- Alessia Azzu
- Royal Brompton Hospital, London, United Kingdom.
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Park YH. Novel Imaging Parameters for Right Ventricular Dysfunction after Pericardiectomy in Constrictive Pericarditis. J Cardiovasc Imaging 2021; 29:373-374. [PMID: 34080353 PMCID: PMC8592677 DOI: 10.4250/jcvi.2021.0074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Yong Hyun Park
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
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Baş S. Dilated right ventricular outflow tract in a young woman due to localized constrictive pericarditis: cardiac CT and MRI findings. Radiol Case Rep 2021; 16:575-578. [PMID: 33408800 PMCID: PMC7773747 DOI: 10.1016/j.radcr.2020.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 11/13/2022] Open
Abstract
We present a case of a dilated right ventricular outflow tract (RVOT) in a 30-year-old woman because of localized constrictive pericarditis where the diagnosis was reached with the help of cardiac CT, and MRI. The patient was suffering from congestive heart failure for two years and had partial pericardiectomy 10 years ago. The diagnostic evaluation of the localized pericarditis requires a multimodality approach and suspected patients would benefit from simple tests, such as X-ray and echocardiography, but also furthermore complex imaging, including cardiac CT and MRI. To our knowledge, our case is the second case in the literature that show localized constrictive pericarditis presenting with giant RVOT and this is the first case that cardiac CT and MRI have been performed.
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Affiliation(s)
- Serap Baş
- Department of Radiology, İstanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital, Çukurçeşme Cad. No:51 Gaziosmanpaşa-İstanbul, Turkey
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Use of Impella RP for Acute Right Ventricular Failure Post-Pericardiectomy. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 28S:176-179. [PMID: 33627297 DOI: 10.1016/j.carrev.2021.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 12/20/2022]
Abstract
Surgical pericardiectomy is the accepted treatment for patients with constrictive pericarditis. Right ventricular failure in patients that undergo pericardiectomy is a frequent complication due to sudden volume overload. Impella RP is used to bypass the right ventricle and tackle the transient right ventricular failure. It is implanted percutaneously and provides enough support to achieve haemodynamical stability and recover end-organ function. We report the case of a patient that developed acute right ventricular failure in the early postoperative period of a pericardiectomy. He underwent the implantation of an Impella RP in the setting of acute right ventricular failure and was successfully explanted after 6 days of support.
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Karima T, Nesrine BZ, Hatem L, Skander BO, Raouf D, Selim C. Constrictive pericarditis: 21 years' experience and review of literature. Pan Afr Med J 2021; 38:141. [PMID: 33912311 PMCID: PMC8052615 DOI: 10.11604/pamj.2021.38.141.22884] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/26/2020] [Indexed: 01/23/2023] Open
Abstract
To the best of our knowledge there are no publications about Tunisian experience in constrictive pericarditis (CP); the aim of this study was therefore to review our twenty-one years’ experience in terms of clinical and surgical outcomes and risk factors of death after pericardiectomy. An analytic bicentric and retrospective study carried out on 25 patients (20 male) with CP underwent pericardiectomy, collected over a 21-years period. The mean age was 40.46±16.74 years [7.5-72]. The commonest comorbid factor was tabagism (52%). The most common etiology was tuberculosis (n = 11, 44%). Dyspnea was the most common functional symptom (n = 21, 84%). Pericardiectomy was performed in all our patients within 2.9±3.19 months after confirmation of diagnosis. It was subtotal in 96% of cases. The commonest postoperative complications are pleural effusion (20%). Dyspnea was regressed within 1.8 months in 80% of cases and clinical signs of right heart failure within a mean duration of 1.62 months in 53% of cases. Perioperative mortality was 12% (3 deaths), late mortality was 4% (1 patient). Cardiopulmonary bypass, New York Heart Association (NYHA) over class II and right ventricular dysfunction are the prognostic factors of mortality (p = 0.001, 0.046, 0.019). Tuberculosis as etiology of CP had no impact on mortality. CP is a rare disease, with non-specific clinical signs. Pericardiectomy is effective with a significant improvement of the functional status of patients and favorable outcome at short and long term nevertheless hospital mortality is not negligible and depends on many factors.
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Affiliation(s)
- Taamallah Karima
- Department of Cardiac Surgery, Military Hospital of Tunis, Tunis, Tunisia
| | - Ben Zaied Nesrine
- Department of Cardiac Surgery, Military Hospital of Tunis, Tunis, Tunisia
| | - Lahdhili Hatem
- Department of Cardiac Surgery, Military Hospital of Tunis, Tunis, Tunisia
| | | | - Denguir Raouf
- Department of Cardiac Surgery, La Rabta Hospital, Tunis, Tunisia
| | - Chenik Selim
- Department of Cardiac Surgery, Military Hospital of Tunis, Tunis, Tunisia
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Nicoara A, Skubas N, Ad N, Finley A, Hahn RT, Mahmood F, Mankad S, Nyman CB, Pagani F, Porter TR, Rehfeldt K, Stone M, Taylor B, Vegas A, Zimmerman KG, Zoghbi WA, Swaminathan M. Guidelines for the Use of Transesophageal Echocardiography to Assist with Surgical Decision-Making in the Operating Room: A Surgery-Based Approach: From the American Society of Echocardiography in Collaboration with the Society of Cardiovascular Anesthesiologists and the Society of Thoracic Surgeons. J Am Soc Echocardiogr 2020; 33:692-734. [PMID: 32503709 DOI: 10.1016/j.echo.2020.03.002] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Intraoperative transesophageal echocardiography is a standard diagnostic and monitoring tool employed in the management of patients undergoing an entire spectrum of cardiac surgical procedures, ranging from "routine" surgical coronary revascularization to complex valve repair, combined procedures, and organ transplantation. Utilizing a protocol as a starting point for imaging in all procedures and all patients enables standardization of image acquisition, reduction in variability in quality of imaging and reporting, and ultimately better patient care. Clear communication of the echocardiographic findings to the surgical team, as well as understanding the impact of new findings on the surgical plan, are paramount. Equally important is the need for complete understanding of the technical steps of the surgical procedures being performed and the complications that may occur, in order to direct the postprocedure evaluation toward aspects directly related to the surgical procedure and to provide pertinent echocardiographic information. The rationale for this document is to outline a systematic approach describing how to apply the existing guidelines to questions on cardiac structure and function specific to the intraoperative environment in open, minimally invasive, or hybrid cardiac surgery procedures.
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Affiliation(s)
| | | | - Niv Ad
- White Oak Medical Center and University of Maryland, Silver Spring, Maryland
| | - Alan Finley
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Feroze Mahmood
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | - Bradley Taylor
- University of Maryland Medical Center, Baltimore, Maryland
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Abdallha M, Ahmed EO, Abdelatti M, Ageel O, Mokhtar M, Farag AMG. Mitral Valve Repair for Severe Mitral Regurgitation Masked by Constrictive Pericarditis Revealed After Pericardiectomy. J Cardiothorac Vasc Anesth 2020; 34:2456-2459. [PMID: 32417004 DOI: 10.1053/j.jvca.2020.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 11/11/2022]
Abstract
A case of severe mitral regurgitation (MR) that was masked by constrictive pericarditis and revealed after pericardiectomy is presented. Diagnosis was made intraoperatively with transesophageal echocardiography. Mitral valve repair was performed using a mitral annuloplasty ring. In some cases, worsening MR after pericardiectomy has been demonstrated to return to baseline with time. In the patient described, MR was severe with secondary ischemic pathology; therefore the decision was made to repair the mitral valve. Intraoperative transesophageal echocardiography played a major role in the decision making.
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Affiliation(s)
- Mohamed Abdallha
- Cardiac Anesthesia Department, King Abdullah Medical City in Holy Capital Makkah, Saudi Arabia
| | - Elnazeer O Ahmed
- Cardiac Surgery Department, King Abdullah Medical City in Holy Capital Makkah, Saudi Arabia
| | - Mohammed Abdelatti
- Cardiac Anesthesia Department, King Abdullah Medical City in Holy Capital Makkah, Saudi Arabia
| | - Omar Ageel
- Cardiac Anesthesia Department, King Abdullah Medical City in Holy Capital Makkah, Saudi Arabia
| | - Mohammed Mokhtar
- Cardiac Anesthesia Department, King Abdullah Medical City in Holy Capital Makkah, Saudi Arabia
| | - Ahmed M G Farag
- Cardiac Anesthesia Department, King Abdullah Medical City in Holy Capital Makkah, Saudi Arabia.
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13
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Calderon-Rojas R, Greason KL, King KS, Oh JK, Stulak JM, Daly RC, Dearani JA, Schaff HV. Tricuspid Valve Regurgitation in Patients Undergoing Pericardiectomy for Constrictive Pericarditis. Semin Thorac Cardiovasc Surg 2020; 32:721-728. [DOI: 10.1053/j.semtcvs.2020.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 11/11/2022]
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Choi MS, Jeong DS, Oh JK, Chang SA, Park SJ, Chung S. Long-term results of radical pericardiectomy for constrictive pericarditis in Korean population. J Cardiothorac Surg 2019; 14:32. [PMID: 30728044 PMCID: PMC6364466 DOI: 10.1186/s13019-019-0845-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 01/14/2019] [Indexed: 11/13/2022] Open
Abstract
Background The 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. Methods Ninety 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. Results The 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. Conclusions Radical 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 material The online version of this article (10.1186/s13019-019-0845-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Min Suk Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Thoracic and Cardiovascular Surgery, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Goyang, Republic of Korea
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Jae K Oh
- Department of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sung-A Chang
- Department of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-Ji Park
- Department of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Suryeun Chung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Choudhry MW, Homsi M, Mastouri R, Feigenbaum H, Sawada SG. Prevalence and Prognostic Value of Right Ventricular Systolic Dysfunction in Patients With Constrictive Pericarditis Who Underwent Pericardiectomy. Am J Cardiol 2015; 116:469-73. [PMID: 26048852 DOI: 10.1016/j.amjcard.2015.04.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/14/2015] [Accepted: 04/14/2015] [Indexed: 11/29/2022]
Abstract
Impaired right ventricular systolic function (RVSF) may complicate the treatment of constrictive pericarditis (CP) by pericardiectomy, which is a procedure that remains with significant morbidity and mortality. We evaluated RVSF in patients with CP who underwent pericardiectomy to determine the prognostic value of RVSF. RVSF was assessed by measuring Tricuspid Annular Plane Systolic Excursion (TAPSE) in 35 patients (mean age 52 ± 15.4 years) who underwent pericardiectomy. Thirty-one patients (88.6%) had reduced RVSF (TAPSE ≤1.8 cm). Eight patients (23%) had postoperative events (heart failure 3 and hospital mortality 5). Logistic regression showed that concomitant coronary artery bypass grafting (CABG) (p = 0.052), left ventricular ejection fraction (p = 0.059), left atrial diameter (p = 0.028), and TAPSE (p = 0.016) were borderline or significant univariate predictors of events. TAPSE (p = 0.018, odds ratio = 0.605 [0.40 to 0.92]) and CABG (p = 0.033, odds ratio = 20 [1.26 to 315]) were independent predictors of events on multivariate analysis. Stepwise analysis showed that TAPSE provided incremental prognostic value (p = 0.029, chi-square increase 11.6 to 16.3) to the combination of CABG, ejection fraction, and left atrial diameter. Receiver-operating characteristic curve analysis showed an area under the curve of 0.815 for TAPSE. TAPSE of 1.38 cm had a sensitivity of 88% and specificity of 67% for identifying patients with events. TAPSE was also inversely related to the length of hospital stay after pericardiectomy (p = 0.02, R = -0.424). Hence, our study showed that RVSF is frequently reduced in patients with CP who underwent pericardiectomy. In conclusion, TAPSE is an independent predictor of events and provides incremental prognostic value to other clinical and echocardiographic variables.
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Affiliation(s)
- Muhammad W Choudhry
- The Krannert Institute of Cardiology, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana
| | - Mohamed Homsi
- The Krannert Institute of Cardiology, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana
| | - Ronald Mastouri
- The Krannert Institute of Cardiology, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana
| | - Harvey Feigenbaum
- The Krannert Institute of Cardiology, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana
| | - Stephen G Sawada
- The Krannert Institute of Cardiology, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana.
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Bennett JM, Pretorius M, Ahmad RM, Eagle SS. Hemodynamic instability in patients undergoing pulmonary embolectomy: institutional experience. J Clin Anesth 2015; 27:207-13. [DOI: 10.1016/j.jclinane.2014.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 08/12/2014] [Accepted: 10/29/2014] [Indexed: 12/29/2022]
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Biventricular Failure due to Stress Cardiomyopathy after Pericardiectomy for Constrictive Pericarditis. Case Rep Med 2013; 2013:106757. [PMID: 24369470 PMCID: PMC3863515 DOI: 10.1155/2013/106757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 10/02/2013] [Accepted: 10/17/2013] [Indexed: 11/17/2022] Open
Abstract
Importance. Constrictive pericarditis is a rare clinical entity that frequently necessitates surgical intervention. Here we present a case of biventricular failure due to stress cardiomyopathy after pericardiectomy. This is an extremely rare complication that is not well described and does not have a definitive mechanism. Observations. A 40-year-old Ecuadorian woman who was found to have constrictive pericarditis due to Mycobacterium tuberculosis infection was referred to our institution. The presence of constrictive pericarditis was confirmed by echocardiography, computed tomography, magnetic resonance imaging, and cardiac catheterization. Following pericardiectomy, the patient developed biventricular failure consistent with stress cardiomyopathy (Takotsubo cardiomyopathy), based on the echocardiographic assessment of the ventricles, which demonstrated an akinetic apex and hyperactive base in both ventricles, the absence of significant epicardial coronary atherosclerosis, and prompt normalization of the cardiac function after intensive medical therapy. Conclusions and Relevance. Biventricular failure in the form of stress cardiomyopathy after pericardiectomy in the manner presented here has not been previously described in the literature. While postulations as to the cause of single ventricle dysfunction have been described, the exact mechanism is unclear and current theories do not explain the clinical features in this case of stress cardiomyopathy after pericardiectomy.
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