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Surgical treatment for chronic constrictive pericarditis
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Pericardiectomy surgery for constrictive pericarditis significantly improved patient functional capacity. This study highlights the benefits of surgical intervention for severe pericardial constriction, with most patients experiencing improved New York Heart Association class post-operation.
Area of Science:
- Cardiology
- Thoracic Surgery
- Internal Medicine
Background:
- Constrictive pericarditis presents with significant hemodynamic compromise.
- Patients often exhibit advanced New York Heart Association (NYHA) functional classes (III or IV) with symptoms like ascites and hepatomegaly.
Purpose of the Study:
- To evaluate the outcomes of pericardiectomy in patients with severe constrictive pericarditis.
- To assess the impact of surgical intervention on patient functional status and mortality.
Main Methods:
- A retrospective analysis of 112 patients undergoing pericardiectomy for constrictive pericarditis between 1963 and 1987.
- Surgical approaches included left anterior thoracotomy (92 cases) and median sternotomy (20 cases).
- Patient outcomes were assessed based on NYHA classification and early mortality.
Main Results:
- Early mortality was 18.75% (21 cases), primarily associated with preoperative patient disability.
- Postoperatively, 80 patients improved to NYHA class I or II within six months.
- Six patients remained in NYHA class III, indicating partial recovery.
Conclusions:
- Pericardiectomy is an effective treatment for hemodynamically significant constrictive pericarditis.
- Surgical intervention leads to substantial functional improvement in the majority of patients.
- Preoperative patient condition is a critical factor influencing early surgical outcomes.
Abstract:
One hundred and twelve patients were operated for constrictive pericarditis from December 1963 through May 1987 at J.J. Group of Hospitals, Bombay. All the patients had haemodynamically significant pericardial constriction preoperatively, and pericardial disease was confirmed at operation. Preoperatively, the patients were either in NYHA class III (96 cases), or class IV (16 cases). All the patients had ascites and/or peripheral oedema with an enlarged liver. Pericardiectomy was performed through a left anterior thoracotomy (92 cases), or median sternotomy (20 cases). There was an early mortality (deaths occurring within 30 days of operation) in 21 cases (18.75%). Early mortality was related to preoperative disability of the patients. Post-operatively, NYHA classification of patients at six months after operation showed improvement in functional class with 80 patients in either class I or II and 6 patients in class III.