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[Surgical treatment of constrictive pericarditis and life-threatening pericardic effusions (author's transl)]
Insights
Surgical pericardectomy, involving total excision of the pericardic sac and epicardium, is the primary treatment for chronic constrictive pericarditis. Drainage via infraxiphoid incision is effective for acute pericarditis with effusion.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Pericardial Disease
Context:
- Chronic constrictive pericarditis necessitates surgical intervention.
- Acute pericarditis with effusion requires tailored management strategies.
- Extracorporeal circulation may be needed for complex cardiac cases.
Purpose:
- To outline the surgical procedures for chronic constrictive pericarditis.
- To describe management options for acute pericarditis with effusion.
- To highlight pericardectomy as the definitive treatment for recurrent or severe pericardial disease.
Summary:
- The standard surgical approach for chronic constrictive pericarditis involves total pericardectomy via sternotomy.
- Femoro-femoral shunt with extracorporeal circulation is utilized for hemodynamic instability or cardiac injury.
- For acute pericarditis with effusion, infraxiphoid drainage is a safe initial method, with pericardectomy considered for relapsing or constrictive progression.
Impact:
- Establishes pericardectomy as the optimal procedure for preventing long-term sequelae of pericarditis.
- Provides guidance on surgical decision-making based on disease acuity and patient stability.
- Improves understanding of therapeutic options for diverse pericardial conditions.
Abstract:
Total excision of both pericardic sac and epicardium is the basic surgical procedure for chronic constrictive pericarditis. Approach being through a vertical sternotomy. In case of either cardiac injury or poor haemodynamic of either cardiac injury or poor haemodynamic conditions, it is sometimes indicated to get help from an extracorporal circulation with femoro-femoral shunt. Surgery for acute pericarditis may vary according to local and general conditions. As soon as a pericardic effusion, whether or not infected, has occurred, drainage by means of an infraxiphoid incision seems to be a safe method. Where pericardic effusions relapse or densify to a constrictive pericarditis, pericardectomy is to be considered. Total pericardectomy is therefore regarded as the best procedure to prevent further disease.