Pericardiectomy for a patient with constrictive pericarditis and multivessel coronary artery disease

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Interventional Cardiology

Background:

• Constrictive pericarditis with multivessel coronary artery disease presents a rare surgical challenge.
• Limited clinical experience exists for pericardiectomy in patients with concomitant coronary artery disease.

Purpose of the Study:

• To evaluate the safety and efficacy of performing pericardiectomy alone, without coronary revascularization, in a patient with tuberculous constrictive pericarditis and multivessel coronary artery disease.
• To assess the utility of intra-aortic balloon pumping (IABP) support during this procedure.

Main Methods:

• A single patient with tuberculous constrictive pericarditis and multivessel coronary artery disease underwent pericardiectomy.
• The procedure was supported by intra-aortic balloon pumping (IABP) as the patient declined revascularization.
• Cardiopulmonary bypass was avoided to mitigate associated risks.

Main Results:

• The patient's postoperative course was uneventful, demonstrating successful management without cardiopulmonary bypass.
• The use of IABP effectively supported the patient during the isolated pericardiectomy procedure.
• Avoiding cardiopulmonary bypass was deemed appropriate given the patient's refusal of revascularization.

Conclusions:

• Performing pericardiectomy alone under IABP support is a safe and effective strategy for select patients with constrictive pericarditis and coronary artery disease.
• This approach is particularly viable when patients refuse revascularization and maintain normal left ventricular ejection fraction.
• The study highlights an alternative management strategy to traditional combined procedures, minimizing risks associated with cardiopulmonary bypass.