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Published on: November 28, 2018
Intraoperative Assessment of Hepatic Vein Tracings in Constrictive Pericarditis During Surgical Pericardiectomy
Mohammad A Helwani1, Sarah Alber1, Charl J DeWet1
1Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO.
Insights
Constrictive pericarditis diagnosis using transesophageal echocardiography during positive pressure ventilation is explored. Hepatic vein Doppler flow effectively monitors diastolic function improvement after pericardiectomy.
Area of Science:
- Cardiology
- Medical Imaging
- Surgical Procedures
Background:
- Constrictive pericarditis presents with heart failure due to pericardial inflammation and fibrosis.
- Surgical pericardiectomy is the primary treatment for constrictive pericarditis.
- Echocardiography is established for diagnosis during spontaneous ventilation, but data are limited with positive pressure ventilation.
Purpose of the Study:
- To evaluate transesophageal echocardiography with positive pressure ventilation for constrictive pericarditis assessment.
- To demonstrate the utility of intraoperative hepatic vein Doppler flow in monitoring treatment response.
Main Methods:
- Case study involving a patient undergoing pericardiectomy for constrictive pericarditis.
- Utilized transesophageal echocardiography with positive pressure ventilation.
- Analyzed intraoperative hepatic vein Doppler flow patterns.
Main Results:
- Observed a blunted diastolic flow pattern in the hepatic vein pre-pericardiectomy.
- Demonstrated reversal of this blunted flow post-successful pericardiectomy.
- Noted blunted systolic compared to diastolic flow post-surgery, indicating elevated right atrial pressure.
Conclusions:
- Transesophageal echocardiography with positive pressure ventilation can assess constrictive pericarditis.
- Hepatic vein Doppler is a valuable tool for intraoperative assessment of diastolic function and right atrial pressure changes after pericardiectomy.
Abstract:
CONSTRICTIVE PERICARDITIS is characterized by progressive inflammation and fibrosis of the pericardium. It manifests with symptoms of heart failure. The only effective treatment is surgical pericardiectomy. The assessment and diagnosis of constrictive pericarditis with echocardiography is well described with spontaneous ventilation. However, there are limited data on constrictive pericarditis assessment with transesophageal echocardiography with positive pressure ventilation. Also, intraoperative hepatic venous Doppler flow mostly is used intraoperatively to assess the severity of tricuspid regurgitation by focusing on the flow reversal during systole. In this e-challenge, the authors focus on the hepatic vein Doppler tracing as a means to show improvement in diastolic function during positive pressure ventilation in a patient undergoing pericardiectomy. This case demonstrates a severely blunted diastolic flow pattern in the hepatic vein that is reversed after successful pericardiectomy. Also, it shows blunted flow during systole compared to diastole post-pericardiectomy, indicating high right atrial pressure.
