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Pericardiectomy for constrictive pericarditis in a resource constraint setting
Isaac Okyere1,2, Perditer Okyere3, Emmanuel Ameyaw4
1Department of Surgery, Kwame Nkrumah University of Science, Kumasi, Ghana.
Insights
Surgical pericardiectomy effectively treats constrictive pericarditis, improving patient outcomes. This standard treatment shows excellent results, even in resource-limited settings for managing this heart condition.
Area of Science:
- Cardiology
- Thoracic Surgery
- Internal Medicine
Background:
- Constrictive pericarditis results from chronic inflammation, leading to a stiff pericardium and impaired heart function.
- This condition causes significant diastolic dysfunction and systemic congestion, representing the advanced stage of pericarditis.
Purpose of the Study:
- To assess the clinical characteristics, diagnostic methods, surgical treatment, and outcomes of constrictive pericarditis patients.
- The study focuses on management within a tertiary hospital setting in Ghana.
Main Methods:
- Retrospective analysis of medical records for patients who underwent pericardiectomy.
- Data collected included patient demographics, preoperative diagnostics, surgical approach, operative details, and postoperative outcomes.
Main Results:
- Ten patients (80% male, mean age 20.4 years) underwent pericardiectomy via median sternotomy.
- Post-surgery, 90% of patients improved to NYHA class I, with a mean follow-up of 19.3 months.
- One patient died from heart failure, and one was lost to follow-up.
Conclusions:
- Median sternotomy pericardiectomy is the established treatment for constrictive pericarditis.
- The procedure yields excellent outcomes, proving effective even in resource-constrained environments.
Introduction:
Constrictive pericarditis is the endpoint of the natural history of acute pericarditis of different aetiologies where a chronic inflammatory process results in a thickened, fibrotic and inelastic pericardium with consequent impairment of diastolic function and systemic congestion.
Aim:
To evaluate the clinical features, diagnosis, surgical management and outcome of patients with constrictive pericarditis as managed in a local setting of a tertiary hospital in Ghana.
Material And Methods:
A retrospective review of the medical records of patients who had undergone pericardiectomy for constrictive pericarditis at a teaching hospital.
Results:
Ten patients underwent pericardiectomy for the period of study. There were 8 (80%) males and 2 (20%) females. The mean age was 20.4 ±17.2 years. Six of the patients 6 (60%) were in NYHA class III. Preoperative diagnostics included chest X-ray, echocardiography, and computed tomography scan. The surgical approach for the pericardiectomy was median sternotomy. The mean operative time was 159.9 ±43.0 min. The mean postoperative days spent before being discharged was 6.9 ±2.3 days. Nine (90%) of the patients were in NYHA class I after a mean follow-up of 19.3 ±16.7 months. One patient died 6 weeks after surgery with heart failure and one patient was lost to follow-up.
Conclusions:
Surgical pericardiectomy via median sternotomy is still the standard modality of treatment for constrictive pericarditis with excellent results even in resource constraint settings.
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