Anterior Pericardiectomy Research Articles

TREATMENT OF URÆMIC PERICARDITIS BY ANTERIOR PERICARDIECTOMY

Mortality, morbidity, and length of hospital stay have been evaluated in 16 dialysis patients who developed pericarditis and were treated with anterior pericardiectomy followed by 24-48 hours of chest-tube drainage. There was no mortality and only minor morbidity. All patients had clinical improvement, with resolution of fever, pain, leucocytosis, and pericardial rub within four days. Average postoperative hospital stay was 13 days. No patient developed recurrent or constrictive pericarditis (maximum follow-up 60 months). In dialysis patients who develop pericarditis with progressive effusion, anterior pericardiectomy reduces mortality, morbidity, and stay in hospital, prevents recurrence of the disease, and may improve healing of the inflamed pericardium.

Cardiac tamponade in uremic pericarditis: Surgical approach and management

More cases of uremic pericarditis are successfully treated by the clinician as a result of improved techniques of dialysis and kidney transplantation. Cardiac tamponade, a further complication of uremic pericarditis, must be treated by pericardiocentesis. If the clinical condition has not been improved after pericardiocentesis, anterior pericardiectomy may be performed with excellent results. Peritoneal dialysis or hemodialysis with regional heparinization is performed as necessary before and after surgery to control the biochemical changes of uremia. During the 3 years from 1970 to 1972, nine patients underwent anterior pericardiectomy for relief of cardiac tamponade in our institution. Seven patients made an uneventful recovery and were discharged to resume long-term intermittent dialysis; two of these patients later received kidney transplants.

THE SURGICAL MANAGEMENT OF ACUTE PERICARDITIS.

1. Six cases of acute pericarditis, three of which are discussed, required pericardiectomy after failure to respond to medical therapy. 2. Reference is made to etiologic agents, operative approach and extent of the pericardiectomy to relieve tamponade and prevent constriction. 3. Median sternotomy approach with removal of the pericardium anterior to and surrounding the hilar structures of the lung is the procedure of choice while the left anterolateral approach with anterior and left pericardiectomy may suffice for cases with acute onset and of short duration. Transthoracic drainage is preferable to external drainage. 4. A plea is made for better timing and a more aggressive attitude to avoid critical situations and operations performed under life-threatening circumstances. 5. The physiology of pericardial effusion-tamponade is discussed.