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Pericardiectomy for constrictive pericarditis: is prolonged inotropic support a bad omen?
A Kohli1, K S Rao, M Nachiappan
1Department of Cardiothoracic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry.
Journal of the Indian Medical Association
|May 23, 2002
Summary
Constrictive pericarditis surgery (pericardiectomy) significantly improves patient outcomes, with most patients achieving New York Heart Association Class I post-operation. Early inotropic support is recommended for managing postoperative low cardiac output.
Area of Science:
- Cardiology
- Thoracic Surgery
- Infectious Diseases
Background:
- Constrictive pericarditis significantly impacts cardiac function, often leading to severe symptoms.
- Surgical pericardiectomy is a primary treatment for refractory constrictive pericarditis.
- Tuberculous etiology is a common cause of constrictive pericarditis in endemic regions.
Purpose of the Study:
- To evaluate the outcomes of pericardiectomy for constrictive pericarditis.
- To identify factors influencing postoperative recovery and long-term survival.
- To assess the efficacy of inotropic support in managing postoperative complications.
Main Methods:
- Retrospective analysis of 67 patients undergoing pericardiectomy between 1987 and 1998.
- Pre-operative assessment of New York Heart Association (NYHA) class and clinical signs.
- Evaluation of operative approach (median sternotomy vs. thoracotomy) and postoperative management, including inotropic support.
Main Results:
- Pre-operatively, 70% of patients were in NYHA classes III/IV, with high prevalence of raised jugular venous pressure (99%), pleural effusion (77%), pedal edema (61%), and ascites (55%).
- Postoperative low cardiac output occurred in 70% of cases, managed with inotropes.
- Histological confirmation of tuberculous pathology in 57% of cases.
- At follow-up, 63% of patients improved to NYHA class I.
- Mortality rate was 9%, predominantly in the early experience.
Conclusions:
- Pericardiectomy leads to significant functional improvement in patients with constrictive pericarditis.
- Early and prolonged inotropic support, particularly with adrenaline, is crucial for managing postoperative ventricular dysfunction.
- Pre-operative NYHA class, operative approach, and peri-operative low cardiac output syndrome did not significantly influence long-term outcomes or survival.