Surgical Treatment of Constrictive Pericarditis

ABSTRACT Introduction: The mainstay of the treatment of constrictive pericarditis is pericardiectomy. However, surgery is associated with high early morbidity and mortality and low long-term survival. The aim of this study is to describe our series of pericardiectomies performed over 30 years. Methods: A descriptive, observational, and retrospective analysis of all pericardiectomies performed at the Institute of Cardiology and Cardiovascular Surgery of the Favaloro Foundation was performed. Results: A total of 45 patients underwent pericardiectomy between June 1992 and June 2022, mean age was 52 years (standard deviation ± 13.9 years), and 73.3% were men. Idiopathic constrictive pericarditis was the most prevalent (46.6%). The variables significantly associated with prolonged hospitalization were preoperative advanced functional class (incidence of 38.4%, P<0.04), persistent pleural effusion (incidence of 81.8%, P<0.01), and although there was no statistical significance with the use of cardiopulmonary bypass, a trend in this association is evident (P<0.07). We found that 100% of the patients with an onset of symptoms greater than six months had a prolonged hospital stay. In-hospital mortality was 6.6%, and 30-day mortality was 8.8%. The preserved functional class is 17 times more likely to improve their symptomatology after pericardiectomy (odds ratio 17, 95% confidence interval 2.66-71; P<0.05). Conclusion: Advanced functional class at the time of pericardiectomy is the variable most strongly associated with mortality and prolonged hospitalization. Onset of the symptoms greater than six months is also a poor prognostic factor mainly associated with prolonged hospitalization; based on these data, we strongly support the recommendation of early intervention.

Damage control in penetrating cardiac trauma / El control de daños en el trauma cardíaco penetrante

Abstract Definitive management of hemodynamically stable patients with penetrating cardiac injuries remains controversial between those who propose aggressive invasive care versus those who opt for a less invasive or non-operative approach. This controversy even extends to cases of hemodynamically unstable patients in which damage control surgery is thought to be useful and effective. The aim of this article is to delineate our experience in the surgical management of penetrating cardiac injuries via the creation of a clear and practical algorithm that includes basic principles of damage control surgery. We recommend that all patients with precordial penetrating injuries undergo trans-thoracic ultrasound screening as an integral component of their initial evaluation. In those patients who arrive hemodynamically stable but have a positive ultrasound, a pericardial window with lavage and drainage should follow. We want to emphasize the importance of the pericardial lavage and drainage in the surgical management algorithm of these patients. Before this concept, all positive pericardial windows ended up in an open chest exploration. With the coming of the pericardial lavage and drainage procedure, the reported literature and our experience have shown that 25% of positive pericardial windows do not benefit and/or require further invasive procedures. However, in hemodynamically unstable patients, damage control surgery may still be required to control ongoing bleeding. For this purpose, we propose a surgical management algorithm that includes all of these essential clinical aspects in the care of these patients.

Resumen El manejo definitivo de los pacientes hemodinámicamente estables con heridas cardíacas penetrantes continúa siendo controversial con abordajes invasivos versus manejos conservadores. Estas posiciones contrarias se extienden hasta aquellos casos de pacientes hemodinámicamente inestables donde se ha descrito y considerado la cirugía de control de daños como un procedimiento útil y efectivo. El objetivo de este artículo es presentar la experiencia en el manejo quirúrgico de heridas cardíacas penetrantes con la creación de un algoritmo práctico que incluye los principios básicos del control de daños. Se recomienda que a todos los pacientes con heridas precordiales penetrantes se les debe realizar un ultrasonido torácico como componente integral de la evaluación inicial. Aquellos que presenten un ultrasonido torácico positivo y se encuentren hemodinámicamente estables se les debe realizar una ventana pericárdica con posterior lavado. Se ha demostrado que el 25% de las ventanas pericárdicas positivas no se benefician ni requieren de posteriores abordajes quirúrgicos invasivos. Antes de este concepto, todos los pacientes con ventana pericárdica positiva terminaban en una exploración abierta del tórax y del pericárdico. Los pacientes hemodinámicamente inestables requieren de una cirugía de control de daños para un adecuado y oportuno control del sangrado. Con este propósito, se propone un algoritmo de manejo quirúrgico que incluye todos estos aspectos esenciales en el abordaje de este grupo de pacientes.

A Recurrent Case of Constrictive Pericarditis after Pericardiectomy Using ePTFE Pericardial Substitution / 日本心臓血管外科学会雑誌

A 67-year-old man developed the recurrence of postoperative constrictive pericarditis. He had two operation histories : the one was CABG for old myocardial infarction and the other was pericardiectomy for postoperative pericarditis at 57 and 59 years old respectively. Both operations were performed in our hospital. We used an ePTFE sheet for covering the heart in the pericardiectomy. The course post operation was good, but eight years after the pericardiectomy, he had abdominal distension and leg edema. Detailed studies revealed a recurrence of constrictive pericarditis, and reoperation was performed. The re-operative finding showed thickened sclerotic tissues on both sides of an ePTFE sheet which was applied to the cardiac surface during the previous surgery. No abnormal tissue was detected where the ePTFE sheet was not applied. The ePTFE sheet and the sclerotic tissues were removed under cardiopulmonary bypass support, and then diastolic dysfunction improved dramatically. His chest was closed without applying an ePTFE sheet. His post-operative course was uneventful and he was discharged on the 20th postoperative day. The ePTFE sheet was highly suspected as a cause of the recurrent constrictive pericarditis. An ePTFE sheet-induced constrictive pericarditis should be considered as one of the postoperative complications even in the mid and long-term period. The ePTFE sheet is useful for preventing heart or vascular injury when we perform resternotomy, but in rare cases, there is some possibility of association with a risk of pericarditis.

Caso Clínico: Mesotelioma primario de pericardio / Case Report: Primary Pericardial Mesothelioma / Case Report: Primary Pericardial Mesothelioma

INTRODUCCIÓN: El mesotelioma primario de pericardio (MPP) es un tumor de origen mesodérmico muy raro dentro de las patologías oncológicas; con una incidencia muy baja. Se han descrito aproximadamente 350 casos alrededor del mundo, siendo la mayoría diagnósticos post mortem. El pronóstico es malo a corto plazo, independientemente del tratamiento a instaurarse, siendo este por lo general únicamente paliativo. A continuación presentamos un caso clínico a propósito de esta patología. CASO CLÍNICO: Paciente de 69 años hospitalizado con cuadro de disnea progresiva y anemia severa. En exámenes complementarios de imagen se evidenció derrame pleural y derrame pericárdico. El reporte histopatológico del líquido pericárdico fue positivo para mesotelioma pericárdico. EVOLUCIÓN: Debido a derrame pericárdico recurrente se decidió realizar pericardiectomía más pleurectomía izquierda como tratamiento paliativo, para aliviar la sintomatología del paciente. Se propuso continuar con quimioterapia, sin embargo, el estado general del paciente se deterioró llevando al fallecimiento. CONCLUSIÓN: El mesotelioma primario de pericárdico es un tumor extremadamente raro, cuya clínica se caracteriza por sintomatología asociada al derrame pericárdico, siendo debido a su baja incidencia un diagnóstico difícil. El pronóstico es malo a corto plazo y no se encuentra un protocolo establecido con resultados que mejoren la mortalidad.

BACKGROUND: Primary pericardial mesothelioma is an extremely rare mesodermal tumor, among oncological diseases, with a very low incidence. About 350 cases have been described around the world, most of them diagnosed post-mortem. The short term prognosis is poor, regardless of the treatment, which is mostly palliative. We present a case report regarding this pathology. CASE REPORT: 69 year old patient hospitalized with dyspnea and severe anemia. Complementary workup showed pleural effusion and pericardial effusion. Histopathology report of the pericardial fluid revealed pericardial mesothelioma. EVOLUTION: Due to recurrence of pericardial effusion, it was decided to perform pericardiectomy and left pleurectomy as palliative treatment, to alleviate the patient's symptoms. Chemotherapy was planned after the procedure, but the patient's general condition deteriorated severely leading to his death. CONCLUSION: Primary pericardial mesothelioma is a rare tumor, whose symptoms are characterized by the associated pericardial effusion, making the diagnosis difficult due to it low incidence. The prognosis is poor in short- term, and there isn't an established protocol for the treatment with results that showed improve in mortality.

Constrictive pericarditis with extensive calcification and caseous necrosis

Abstract Constrictive pericarditis is a disease where loss of pericardial elasticity and restriction of filling of the cardiac chambers occurs. It is most often seen as an associated symptom of heart failure. Pericardiectomy provides effective treatment for patients with symptomatic constrictive pericarditis, although high rates of morbidity and mortality are related to the procedure. We present a case with extensive calcification, massive caseous necrosis and an important impairment of right ventricular function successfully operated in our institution.

Tratamiento quirúrgico de la pericarditis purulenta: reporte de un caso / Surgical treatment of purulent pericarditis: report of a case

Resumen Introducción: La pericarditis es la enfermedad del pericardio más presente en la práctica médica. La pericarditis purulenta representa el 5% de ellas, con una mortalidad de hasta el 40%. Caso Clínico: Se presenta un paciente masculino, de 27 años de edad, con antecedentes de hipotiroidismo que ingresa con tos y expectoración amarillenta, asociado a fiebre, que resolvió con tratamiento antibiótico. Un mes después, reingresa con dolor abdominal, astenia y disnea intensa que no tolera el decúbito. Se indica ecocardiograma, que diagnostica derrame pericárdico severo, con colapso de cavidades derechas. Se procedió a pericardiocentesis de emergencia, donde se extrajeron 450 mililitros de líquido purulento. En el seguimiento ecocardiográfico a las 48 h, se observa aumento del derrame, por lo que se decide tratamiento quirúrgico, mediante toracotomía anterolateral izquierda, encontrando derrame purulento y engrosamiento pericárdico de 6 mm, con múltiples adherencias. Se indica pericardiectomía parcial. El paciente evolucionó favorablemente, egresándose 7 días posteriores a la cirugía.

Introduction: Pericarditis is frecuent pericardial disease in medical practice. The purulent pericarditis represents 5%, with a mortality of up to 40%. Case Report: We present a male patient, 27 years old, with a history of hypothyroidism that enters with cough and yellowish expectoration, associated with fever, resolved with antibiotic treatment. One month later, he reenters with abdominal pain, asthenia and intense dyspnea that does not tolerate decubitus. Echocardiogram diagnosed severe pericardial effusion, with collapse of right cavities. Emergency pericardiocentesis was performed and 450 milliliters of purulent fluid were extracted. In the echocardiographic follow-up at 48 hours, an increase in the effusion was observed, was decided surgical treatment by left anterolateral thoracotomy, finding purulent effusion and pericardial thickening of 6 mm, with multiple adhesions. Partial pericardiectomy is indicated. The patient evolved favorably, leaving 7 days after surgery.

A Case of Protein-Losing Gastroenteropathy due to Constrictive Pericarditis after Cardiac Surgery / 日本心臓血管外科学会雑誌

A 36-year-old man underwent direct closure of an atrial septal defect through median sternotomy at the age of 14. He also underwent a mitral valve replacement with tricuspid annuloplasty using the same approach at the age of 18. The patient also presented with pretibial edema and congestive liver disease at the age of 27 and the pretibial edema progressed at the age of 35. Hypoalbuminemia (TP ; 3.6 g/dl, Alb ; 1.6 g/dl) was also observed. Further examinations were performed, which revealed that the right ventricular pressure curve presented a dip and plateau pattern by cardiac catheterization. Computed tomography of the chest additionally revealed thickened and calcified pericardium in the left ventricle. Abdominal scintigraphy showed tracer accumulation in the transverse colon hepatic flexure 4 h after intravenous administration of technetium-99m-labelled human serum albumin. The patient was diagnosed with a protein-losing gastroenteropathy caused by constrictive pericarditis. He underwent pericardiectomy via left anterior thoracotomy without cardiopulmonary bypass. No complications were present after the surgery, and he was discharged after 46 postoperative days. Following his discharge from the hospital, the pretibial edema disappeared, and serum albumin levels gradually increased and normalized within 3 months after the surgery (TP 7.1 g/dl, Alb 4.2 g/dl).

Pericarditis Constrictiva, variedad fibroelástica. Nuevas técnicas diagnósticas por imágenes / Constrictive Fibrous Pericarditis. Novel Diagnostic Imaging Techniques

Abstract Constrictive Pericarditis is a disease characterized by fibrous thickening of the pericardium that generates a failure in cardiac function. The case of a 54-year-old man, marathon runner with progressive symptoms of congestive heart failure and significantly reduction of Functional Class II-III (NYHA) lasting seven months is presented. Clinical findings are described and the diagnostic value of several imaging techniques - echocardiography, multi-slice computerized tomography and cardiac magnetic resonance - is emphasized. Constrictive fibrous pericarditis was confirmed at pericardiectomy.

Chronic constrictive pericarditis: an “Egg-Shell” calcification

Chronic constrictive pericarditis is a condition marked by scarred and inelastic pericardium with excessive fibrous tissue and calcium. Here, we report a case of Egg-Shell like calcification in a 30-year-old young adult diagnosed with chronic constrictive pericarditis. The patient was successfully managed with very good prognosis post-pericardiectomy.

A Case of Constrictive Pericarditis Occurring One Month after Coronary Artery Bypass Graft / 日本心臓血管外科学会雑誌

A 81-year-old man underwent CABG for angina pectoris. The grafts were all patent in postoperative coronary angiography and he was discharged on postoperative day 24. Pericardial and pleural effusion appeared in 1 month after surgery. After pericardial and pleural effusion drainage, we started steroid therapy. However, his symptoms did not improve. We performed pericardiectomy under the diagnosis of constrictive pericarditis. Diastolic dysfunction improved after the surgery, and he was discharged on postoperative day 117.

Clinical and surgical outcomes of pericardiectomy done by total anterolateral thoracotomy

Introduction: Constrictive Pericarditis is a chronic inflammatory process that leads to progressive pericardial fibrosis encasing the heart in a thickened and fibrotic pericardium. This leads to impaired diastolic filling of the cardiac chambers, end result of reduced cardiac output. Aim of study: To analyze the perspectives of clinical outcomes and surgical results of pericardiectomy (total or subtotal) done by left anterolateral thoracotomy. Materials and methods: Totally 20 patients were included in the study. The study was conducted in the department of cardiothoracic surgery, Government Mohan Kumaramangalam Medical College Hospital, From 2013-2017. Regardless of the age group, resection of the diseased pericardium was essential for minimizing early morbidity and mortality and improving long-term functional results and quality of life. This study was designed to compare two types of surgical technique of pericardiectomy, total and subtotal pericardiectomy by left anterolateral thoracotomy. Results: There was a lesser degree of pulmonary complications in both the groups' patients requiring antibiotic therapy and two patients required bronchoscopy for retained secretions and two patients had a pleural effusion, which required drainage. Conclusion: The results of pericardiectomy in terms of improvement in NYHA status and mortality are similar in both types of resection. The combination of chemotherapy and surgery yields good results in the treatment of tuberculosis pericarditis.

Cardiac surgery in a patient with implanted vagal nerve stimulator

The prevalence of epilepsy worldwide is around 0.5%–2% of the population. Antiepileptic medications are the first line of treatment in most of the cases but approximately 25%–30% epilepsy patients are refractory to the single or combination therapy. The surgical option for temporal lobe epilepsy is temporal lobectomy, which has its inherent risk of neurological deficits after the surgery. Patients who are either refractory to combination therapy or do not want surgical temporal lobectomy are the candidates for electrical stimulation therapy. Refractory cases require implantable device such as vagal nerve stimulator (VNS). We are reporting perioperative management of a patient, with an implanted VNS, posted for pericardiectomy. It is important for the anesthesiologist to be familiar with the mechanism of VNS for proper perioperative care.

A Case of Constrictive Pericarditis after Minimally Invasive Mitral Valve Surgery Requiring Pericardiectomy / 日本心臓血管外科学会雑誌

A 68-year-old man was referred to our hospital for mitral valve stenosis, tricuspid valve insufficiency and atrial fibrillation. We performed mitral valve replacement, tricuspid valve plasty, and the MAZE operation through a right small thoracotomy under endoscopic assistance. He was discharged uneventfully 7 days after the operation. However, about 2 months later, he developed pericardial effusion, right pleural effusion, and leg edema implying as having right heart failure. Although he was treated with diuretics and steroids, improvement was temporary and he was hospitalized repeatedly. Cardiac catheterization demonstrated dip and plateau pattern of the right ventricular pressure curve. We diagnosed that he has constrictive pericarditis, although the finding of the chest CT was non-specific without remarkable thickening or calcification of the pericardium. We performed pericardiectomy through median sternotomy without pump assist. Leather-like thickening of the pericardium was recognized in the right, anterior, and inferior portion. Resection of the thickened pericardium led to instantaneous improvement of right ventricular motion and drop of central venous pressure. The patient is in NYHA Class I, one year after pericardiectomy. Constrictive pericarditis could occur even after minimally invasive surgery, and that possibility should be kept in mind if intractable right heart failure persists.

Importance of Clinical and Laboratory Findings in the Diagnosis and Surgical Prognosis of Patients with Constrictive Pericarditis / Importância dos Achados Clínicos e Laboratoriais no Diagnóstico e Prognóstico Cirúrgico de Pacientes com Pericardite Constritiva

Abstract Background: International studies have reported the value of the clinical profile and laboratory findings in the diagnosis of constrictive pericarditis. However, Brazilian population data are scarce. Objective: To assess the clinical characteristics, sensitivity of imaging tests and factors related to the death of patients with constrictive pericarditis undergoing pericardiectomy. Methods: Patients with constrictive pericarditis surgically confirmed were retrospectively assessed regarding their clinical and laboratory variables. Two methods were used: transthoracic echocardiography and cardiac magnetic resonance imaging. Mortality predictors were determined by use of univariate analysis with Cox proportional hazards model and hazard ratio. All tests were two-tailed, and an alpha error ≤ 5% was considered statically significant. Results: We studied 84 patients (mean age, 44 ± 17.9 years; 67% male). Signs and symptoms of predominantly right heart failure were present with jugular venous distention, edema and ascites in 89%, 89% and 62% of the cases, respectively. Idiopathic etiology was present in 69.1%, followed by tuberculosis (21%). Despite the advanced heart failure degree, low BNP levels (median, 157 pg/mL) were found. The diagnostic sensitivities for constriction of echocardiography and magnetic resonance imaging were 53.6% and 95.9%, respectively. There were 9 deaths (10.7%), and the risk factors were: anemia, BNP and C reactive protein levels, pulmonary hypertension >55 mm Hg, and atrial fibrillation. Conclusions: Magnetic resonance imaging had better diagnostic sensitivity. Clinical, laboratory and imaging markers were associated with death.

Resumo Fundamento: Estudos internacionais têm relatado o valor de perfil clínico e exames de imagem no diagnóstico e prognóstico da pericardite constritiva. Entretanto, dados da população brasileira são escassos. Objetivo: Avaliar as características clínicas, sensibilidade de exames de imagem e fatores relacionados ao óbito em uma série de casos de pericardite constritiva submetidos à pericardiectomia. Métodos: Pacientes com pericardite constritiva confirmada por cirurgia foram avaliados retrospectivamente quanto a variáveis clínicas e laboratoriais. Dois métodos diagnósticos foram utilizados: ecocardiograma transtorácico e ressonância cardíaca. Preditores de mortalidade foram determinados por análise univariada usando metodologia das proporções de Cox e hazard ratio. Todos os testes foram considerados bicaudais e um erro alfa ≤ 5% foi considerado como significante. Resultados: Foram estudados 84 pacientes com idade média de 44 ± 17,9 anos, sendo 67% do sexo masculino. Sinais e sintomas de insuficiência cardíaca (IC) predominantemente direita estiveram presentes com estase jugular, edema e ascite em 89%, 89% e 62% dos casos, respectivamente. Etiologia idiopática foi observada em 69% dos casos, seguida por tuberculose em 21%. Apesar do grau de IC, encontramos baixos níveis de BNP (mediana de 157 pg/mL). As sensibilidades diagnósticas para constrição do ecocardiograma e da ressonância foram 53,6% e 95,9%, respectivamente. Durante a evolução clínica, houve 9 óbitos (10,7%) e os fatores de risco foram: anemia, elevações de BNP, PCR, hipertensão pulmonar > 55 mmHg e fibrilação atrial. Conclusões: Pericardite constritiva manifesta-se com sinais e sintomas de IC biventricular com predomínio à direita e baixos níveis de BNP. A ressonância magnética apresenta melhor sensibilidade para diagnóstico. Marcadores clínicos, laboratoriais e de imagem estiveram associados ao óbito.

The Importance of Complete Pericardiectomy and the Role of the Apical Suction Device in Chronic Constrictive Pericarditis

BACKGROUND: The aim of this study was to analyze the preoperative attributes and clinical impacts of complete pericardiectomy in chronic constrictive pericarditis. METHODS: A total of 26 patients were treated from January 2001 to December 2013. The pericardium was resected as widely as possible. When excessive bleeding or hemodynamic instability occurred intraoperatively, a cardiopulmonary bypass (CPB; n=3, 11.5%) or an apical suction device (n=8, 30.8%) was used. Patients were divided into 2 groups: those who underwent ≥ 80% resection of the pericardium (group A, n=18) and those who underwent <80% resection of the pericardium (group B, n=8). RESULTS: The frequency of CPB use was not significantly different between groups A and B (n=2, 11.1% vs. n=1, 12.5%; p=1.000). However, the apical suction device was more frequently applied in group A than group B (n=8, 30.8% vs. n=0, 0.0%; p=0.031). The postoperative New York Heart Association functional classification improved more in group A (p=0.030). Long-term follow-up echocardiography also showed a lower frequency of unresolved constriction in group A than in group B (n=1, 5.60% vs. n=5, 62.5%; p=0.008). CONCLUSION: Patients with chronic constrictive pericarditis demonstrated symptomatic improvement through complete pericardiectomy. Aggressive resection of the pericardium may correct constrictive physiology and an apical suction device can facilitate the approach to the posterolateral aspect of the left ventricle and atrioventricular groove area without the aid of CPB.

Pericarditis constrictiva crónica calcificada idiopática (concretio cordis) / Idiopathic calcific chronic constrictive pericarditis (concretio cordis)

Resumen La pericarditis constrictiva es una enfermedad poco frecuente que resulta de la pérdida de la elasticidad normal del saco pericárdico y la consiguiente cicatrización. Comprende diversas etiologías, pero en un gran porcentaje de los casos es diagnosticada como idiopática. Sus manifestaciones suelen ser crónicas, aunque sus variantes incluyen constricción subaguda, transitoria y oculta. Se presenta el caso de un paciente masculino de 53 años de edad con deterioro de su clase funcional asociado a disnea, frote pericárdico y hallazgos radiológicos de calcificación pericárdica, requiriendo pericardiectomía total.

Abstract Constrictive pericarditis is an uncommon condition resulting from loss of normal elasticity pericardial sac and consequent healing. Although a large percentage of cases are diagnosed as idiopathic. That pathology comprises various etiologies. Its manifestations are usually chronic, but variants include subacute and transient constriction. We present the case of a male patient of 53 years who presented functional class deterioration manifested by dyspnea, pericardial rub and radiological findings confirming pericardial calcification requiring total pericardiectomy.

Pericarditis constrictiva, siempre un desafío diagnóstico / Constrictive pericarditis: always a diagnostic challenge

Reportamos el caso de un hombre de 52 años, con antecedente de larga data de dolor torácico, estudiado el año 2005 con una coronariografía que descarta lesiones en las arterias epicárdicas. Se agrega luego de forma progresiva dolor y distensión abdominal. Sin controles hasta el año 2015, cuando se realiza una endoscopia digestiva alta que no objetiva hallazgos patológicos, encontrándose el paciente en fibrilación auricular e iniciando terapia. A fines del 2016 por persistencia y aumento de las molestias se hospitaliza en nuestro centro para estudio. Se realiza una ecocardiografía que evidencia; severa dilatación biauricular, buena función global y segmentaria bi-ventricular y un movimiento de rebote protodiás-tolico que aumentaba notoriamente en inspiración a nivel del septum interventricular. El pericardio se encontraba engrosado e hiperrefringente de forma difusa, con falta de deslizamiento entre sus hojas y movimiento en bloque de los tejidos blandos adyacentes. Presentaba además comportamiento reverso del anillo mitral al Doppler tisular y la vena cava inferior se encontraba dilatada y sin variación con el ciclo ventilatorio. Un sondeo cardíaco izquierdo y derecho descarta lesiones coronarias y corrobora la fisiología constrictiva. Se amplía el estudio con una tomografía computada de tórax que informa engrosamiento difuso y extensa calcificación del pericardio, además de signos de daño hepático crónico. Se realiza una pericardiotomia exitosa, los hallazgos del intraoperatorio e histopatológicos confirman el diagnóstico de pericarditis constrictiva calcificada. El paciente es dado de alta al quinto día postoperatorio sin incidentes.

We report the case of a 52 y.o. male, with longstanding history of chest pain. Coronariography performed in 2005 showed normal coronary arteries. In the following years he developed progressive abdominal bloating and pain, upper gastrointestinal endoscopy was normal, but atrial fibrillation was diagnosed initiating therapy. During the year 2016 symptoms got worse, being admitted to our hospital. Echocardiography revealed severe biatrial enlargement, preserved bi-ventricular function, and a paradoxical bouncing motion of the interventricular septum which augmented during inspiration (septal bounce). The pericardium was thickened with absence of normal sliding between its layers, and traction of adjacent soft tissues was observed. Mitral ring tissue Doppler showed reversal of lateral and medial e' velocities. Inferior vena cava was dilated with no respiratory variation. Cardiac catheterization was consistent with constrictive pericarditis. Computed tomography confirm extensive pericardial calcification and thickness and found signs of chronic liver disease. Uneventful pericardiectomy was performed, intraoperative and histological findings confirm the diagnostic of calcified pericardial constriction, being discharged on the fifth day post-surgery.

A case of successful extracorporeal membrane oxygenation for right ventricular failure following pericardiectomy

Extracorporeal membrane oxygenation (ECMO) is a useful but less commonly used technique in right ventricular failure post cardiac surgery in our region. We report a case of successful use of ECMO for right ventricular failure post cardiac surgery. Our patient is a 27-year-old male presented with constrictive pericarditis post completion of treatment for disseminated Tuberculosis. He underwent pericardiectomy that was complicated with acute right ventricular failure. He was placed on extracorporeal membrane oxygenation after few hours post op that lasted for five days. The patient survived to hospital discharge and remained well on follow-up. From our experience, this aggressive management approach is beneficial in right ventricular failure and can be safely utilised in all cardiothoracic centres.

Evaluation of left atrial functions in patients with constrictive pericarditis after pericardiectomy by two-dimensional speckle tracking echocardiography / 中华超声影像学杂志

Objective To evaluate the changes of left atrial (LA)functions in patients with constrictive pericarditis (CP)after pericardiectomy by two-dimensional speckle tracking echocardiography (STE).Methods A total of 41 patients with CP underwent echocardiography before and after pericardiectomy.The procedure was performed to obtain global LA longitudinal strain,the septal and lateral walls'longitudinal strain,including peak negative strain (NS),peak positive strain (PS),and total strain (TS),using speckle tracking echocardiography.Thirty-five healthy volunteers were recruited as controls. Results After pericardiectomy,global LA peak negative strain and total strain of CP increased significantly (P 0.05).And three components of LA longitudinal strain were still lower than normal (P <0.005).LA lateral wall's total strain,peak positive strain and peak negative strain improved apparently after pericardiectomy (P <0.005),only peak negative strain increased in LA septum (P < 0.01 ).Conclusions In the early postoperative period,LA reservoir and contractile function presented significant improvements,even notable in the lateral area when compared with septum.However,all three parts of LA function were still lower than normal.STE can regionally estimate LA functions in patients with CP after pericardiectomy.

Primary Purulent Pericarditis with Cardiac Tamponade due to Oropharyngeal Polymicrobial Infection: A Case Report and Literature Review

Cardiac tamponade due to purulent pericarditis with a characteristic greenish fluid is rare in this antibiotic era. It is highly fatal despite early diagnosis and advanced treatment. Gram-positive cocci are the leading cause of purulent pericarditis, which usually results from a direct or hematogenous spread of organisms to the pericardium from the primary foci of infection. We describe an index case of rapidly developing pericardial tamponade caused by oropharyngeal polymicrobial infection in the absence of a primary source of infection in a 62-year-old man, who was successfully managed with emergency large-volume pericardiocentesis followed by pericardiectomy.