Outcome of Pericardiectomy for Constrictive Pericarditis: Single Center Experience

Abstract

Background. Constrictive pericarditis is a rare chronic inflammatory disease that impairs diastolic filling, reduces cardiac output, and ultimately leads to heart failure. TB and post-pericardiotomy and idiopathic are the commonest causes. Multimodality imaging are essential for confirming the diagnosis Trans-thoracic echocardiography is the golden method of diagnosis. Computed tomography is another confirmatory diagnostic tool of pericardial thickness. Right side heart Cath and magnetic resonance imaging help in diagnosis of constrictive pericarditis from restrictive cardiomyopathy and confirm diastolic filling dysfunction of the heart. Pericardiectomy is the mainstay therapy, should be early and complete if feasible to provide symptoms relieve and adequate outcome Patients and methods. We retrospectively review medical records of 13 patients operated for pericardiectomy for constrictive pericarditis. Demographic and perioperative data were analyzed. Results. The mean age of patients was 49.9±7.8 years. All of our patients were symptomatic (NYHA class II-IV) with 7 months median duration of symptoms. TB was the commonest cause. Complete pericardiectomy was achieved in 11 patients (84.6%). Cardiopulmonary bypass was conducted in 5 patients (4 for associated cardiac procedure and one for repair of IVC injury). NYHA class improved to class I in 9 patients (75%). We had one case (7.6%) of mortality. The cause of death was sepsis and respiratory failure. Conclusion. Phrenic to phrenic pericardiectomy without bypass is safe and effective for treating constrictive pericarditis.