Pericarditis: a persisting surgical problem

A study of pericarditis treated surgically over a period of 14.5 years was conducted to evaluate the current pattern and management of this disease in a tropical environment. The series comprised 86 patients (58 males and 28 females) aged from 5 months to 60 years (mean 21.1 years). Pericarditis was effusive in 41 patients, calcific in 33 and fibrous in 12. Aetiological or associated factors were non-specific, pyogenic infection, rheumatic heart disease, endomyocardial fibrosis, tuberculosis and amoebiasis in 36, 21, eight, eight, six and four patients, respectively. All the patients were in New York Heart Association (NYHA) functional class III or IV. Operative treatment involved pericardiotomy with tube drainage in 32 patients, pericardiectomy in 49, and pericardiotomy with subsequent pericardiectomy in five. The total hospital mortality rate was 8.0%, and was largely a result of severe pre-operative cardiac decompensation and multiple organ failure. Of the 79 early survivors, 91% reverted to NYHA functional class I or II. Surgical treatment remains the most effective management of chronic pericarditis which still constitutes a major clinical problem in some countries.