Pericardiectomy for treatment of neoplastic constrictive pericarditis

To share our results of a case series of 8 patients who underwent pericardiectomy for constrictive pericarditis that developed secondary to a known neoplastic disease.

The underlying neoplasia was lung cancer in 5 (62.5%) patients, malignant pleural mesothelioma in 2 (25%), and Hodgkin lymphoma in 1 (12.5%). A diagnosis of constrictive pericarditis was made primarily by echocardiography, and right heart catheterization was performed in 6 (75%) patients. Total pericardiectomy was defined as wide excision of the anterior pericardium. Follow-up information was obtained by telephone interview and the civil registry database.

Time from initial diagnosis of the neoplastic disease ranged from 1 to 15 years. Total pericardiectomy was performed in 6 (75%) patients. Histopathological examination revealed atypical cells in evacuated fluid and pericardial material in 6 patients. Nonspecific inflammation and fibrosis were observed in the other 2 cases. Hospital death occurred in 1 (12.5%) patient. Postoperative low cardiac output syndrome occurred in 7 (87.5%) patients. Follow-up ranged from 2.92 to 26.78 months. Mean survival was 14.82 ± 4.4 months.

Pericardial constriction may develop a long time after the initial presentation of certain neoplastic diseases, and the prognosis after pericardiectomy is poor.