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[Surgical treatment for chronic constrictive pericarditis through a combined median sternotomy and left anterolateral

K Kushibe, S Kitamura, K Kawachi

    Rinsho Kyobu Geka = Japanese Annals of Thoracic Surgery
    |October 1, 1989
    PubMed

    Insights

    This study presents a combined surgical approach for pericardiectomy in patients with chronic calcified constrictive pericarditis. The technique facilitated effective decortication, leading to uneventful patient recovery.

    Area of Science:

    • Cardiovascular Surgery
    • Thoracic Surgery
    • Cardiac Surgery

    Background:

    • Constrictive pericarditis is characterized by pericardial thickening and calcification, restricting diastolic filling.
    • Surgical pericardiectomy is the definitive treatment for symptomatic constrictive pericarditis.
    • Chronic calcified constrictive pericarditis presents surgical challenges due to dense adhesions and calcification.

    Observation:

    • Two male patients (61 and 64 years old) with chronic calcified constrictive pericarditis underwent pericardiectomy.
    • Diagnostic imaging (X-ray, CT) revealed significant pericardial calcification.
    • Cardiac catheterization showed elevated right atrial and ventricular end-diastolic pressures with characteristic right ventricular pressure patterns.

    Findings:

    • A combined midsternotomy and left anterolateral thoracotomy provided an optimal surgical exposure.
    • The combined approach facilitated superior decortication of the lateral and posterior left ventricular surfaces.
    • Both patients experienced uneventful postoperative recovery following the procedure.

    Implications:

    • The combined midsternotomy and anterolateral thoracotomy is an effective surgical strategy for complex pericardiectomy.
    • This approach may improve surgical outcomes and reduce complications in patients with severe pericardial calcification.
    • Enhanced visualization and access during pericardiectomy can lead to more complete myocardial release and improved cardiac function.

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