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[Constrictive pericarditis after cardiac surgery]
J P Remadi1, O al Habash, C Bonnel
1Clinique Chirurgicale Thoracique, Cardiaque et Vasculaire, Höpital G. et R. Laennec, Nantes.
Insights
Constrictive pericarditis is a rare cardiac surgery complication. Early diagnosis and pericardectomy can resolve symptoms, even when initial presentation mimics myocardial failure.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Constrictive pericarditis is a rare but serious complication following cardiac surgery.
- This study investigates the incidence, presentation, and outcomes of constrictive pericarditis post-cardiac surgery.
Observation:
- Five cases of constrictive pericarditis were identified among 7851 cardiac surgery patients (0.63% incidence).
- Patients were male, with symptom onset a mean of 21 months post-surgery, primarily presenting with right ventricular failure.
- Diagnosis was confirmed via right heart catheterization revealing a diastolic dip-plateau pattern.
Findings:
- Radical pericardectomy was performed in four patients, with one managed medically.
- All five patients experienced resolution of clinical signs after treatment.
- The study highlights the diagnostic challenges due to non-specific symptoms mimicking myocardial failure.
Implications:
- Recognizing constrictive pericarditis is crucial for accurate diagnosis and effective management in post-cardiac surgery patients.
- Timely surgical intervention (pericardectomy) can lead to favorable outcomes.
- Clinicians should consider occult constriction in patients with unexplained heart failure symptoms after cardiac surgery.
Abstract:
Constrictive pericarditis is a rare complication of cardiac surgery. Among 7851 patients who underwent cardiac surgery at Nantes University Hospital, postoperative constrictive pericarditis was diagnosed in 5 patients: 0.63%. All patients were men aged 49 to 77 years (mean 62.5) Four patients underwent coronary artery bypass graft surgery and one patient required mitral and aortic valve replacement. The mean time to onset of symptoms after the first operation was 21 months. The main clinical symptom was right ventricular failure. In all patients, the diagnosis was established by right catheterization which showed diastolic dip-plateau. A radical pericardectomy was performed in all but one of the patients, who was treated medically. Clinical signs resolved in all five patients. The diagnosis of constriction after cardiac-surgery is not easy, as the symptoms are non-specific. A symptomatic patient believed to have myocardial failure after cardiac-surgery could therefore actually instead have occult constriction.