Chronic constrictive pericarditis treated with pericardiectomy

Abstract

During the past ten years twenty-six patients have been operated upon at the Cleveland Clinic Hospital for the surgical correction of chronic constrictive pericarditis. There has been considerable variation in technical features of the operation, but with increasing experience the trend is toward one of two basic incisions: (1) the median sternotomy (sternal-splitting) or (2) the transverse sternotomy (sternal transection). Either incision provides excellent exposure of the anterior aspect of the pericardial sac and its contents. Successful decortication is dependent upon the surgical exposure; however, other factors may be of equal significance. The most important of these is the character of the pericardial disease in the patient. The ability to establish a cleavage plane is usually dependent upon the pathologic process itself. Other reasons for failure are myocardial disease and postoperative complications. The cause of chronic constrictive pericarditis is still a matter of interest. Although tuberculous pericarditis was originally presumed to be the responsible cause of constrictive pericarditis, it now appears that this may be comparatively rare. Comparison of a sizable series of patients with acute pcricardial effusion treated during the same time interval suggests a possible relationship between acute hemorrhagic pericarditis and chronic constrictive pericarditis. The investigative problem remains to establish the common cause of acute pericardial hemorrhage and the factors that allow intrapericardial blood to incite a possible constrictive pericarditis.