Development Of Constrictive Pericarditis Research Articles

ЭКСПЕРИМЕНТАЛЬНЫЕ МОДЕЛИ ПЕРИКАРДИТА

The article discusses a pressing issue in cardiac surgery – the development of cicatricial adhesions and complications that arise from adhesive pericarditis, which can transform into a more severe condition known as constrictive pericarditis. The article also delves into the challenges of performing repeated cardiac surgery, the factors that trigger the adhesive process in the pericardium, and the etiopathogenetic mechanisms of fibrogenesis. These mechanisms involve the participation of active immune cells and the release of proinflammatory cytokines. Specifically, the article examines the features involved in the development of constrictive pericarditis, focusing on the cellular and molecular aspects of pericardial remodeling. It also evaluates the surgical and therapeutic measures currently used to prevent complications after cardiac surgery. Using original biological test systems involving experimental animals is advocated for a better understanding of the mechanisms underlying adhesive pericarditis after cardiac surgery and the development of effective prevention strategies. A range of experimental models of adhesions caused by pericarditis during open-heart surgery in mice is presented in this paper. The models include talc-induced pericarditis in mice, pigs, dogs, and rabbits, induced through the intrapericardial injection of Zymosan A, a known activator of the nucleotide-binding domain leucine-rich repeat and pyrin-containing protein 3 (NLRP3) inflammasome. Furthermore, the paper also covers mechanical methods of activation of pericarditis. These experimental models will help researchers explore the potential of new anti-adhesion drug molecules, which can be used in cardiac surgery. Keywords: Cardiac surgery, constrictive pericarditis, mechanisms of fibrogenesis, prevention of pericarditis, experimental models of pericarditis

Intrapericardial recombinant tissue plasminogen activator in purulent pericarditis- case series

BackgroundPericardial constriction is one of the complications of purulent pericarditis (PP). Most difficult to treat, which may develop both in early and in the late period of the disease, resulting in a very poor prognosis.Case presentationWe present case series of 4 patients with purulent pericarditis, in whom direct intrapericardial administration of recombinant tissue plasminogen activator (r-tPA) was used.Management of PP requires a combined surgical and medical approach. The most important is complete drainage of the effusion by subxiphoid pericardiotomy connected with complementary use of broad-spectrum antibiotics. Despite the use of broad- spectrum antibiotics, in some patients a large volume of daily drainage is still present. Constrictive pericarditis as a complication of PP is observed in majority of patients.Intrapericardial administration of fibrinolytic agents, although not strongly recommended, can improve efficacy of antibiotic treatment especially in patients with loculation fluid and can prevent the development of constrictive pericarditis.r-tPA was applied at a dose of 20 mg dissolved in 100 ml of normal saline in a 100 ml syringe, administered by a large pericardial drain (Pezzer drain) installed into the pericardial cavity during pericardioscopy. The tube was closed and re-opened after 24 h.No serious complications, such as bleeding, allergy or hypotension, were noted.ConclusionWe present case series of 4 patients with purulent pericarditis, in whom direct intrapericardial administration of recombinant tissue plasminogen activator (r-tPA), prevented the development of constrictive pericarditis, and increased efficacy of antibiotic treatment without any significant complications.

Primary purulent bacterial pericarditis due to Streptococcus intermedius in an immunocompetent adult: a case report

BackgroundAcute purulent bacterial pericarditis is of rare occurrence in this modern antibiotic era. Primary involvement of the pericardium without evidence of underlying infection elsewhere is even rarer. It is a rapidly progressive infection with high mortality. We present an extremely rare case of acute purulent bacterial pericarditis in an immunocompetent adult patient with no underlying chronic medical conditions.Case presentationA 33-year-old previously healthy white man presented with the complaints of chest pain and dyspnea. He was diagnosed as having acute pericarditis and was discharged home on indomethacin. Over a period of 2 weeks, his symptoms worsened gradually and he was readmitted to our hospital. He was found to have large pericardial effusion with cardiac tamponade. An urgent pericardiocentesis was done with drainage of 550 ml of purulent material. Cultures grew Streptococcus intermedius confirming the diagnosis of acute purulent bacterial pericarditis. No other focus of infection was identified on imaging workup suggesting primary infection of the pericardium. His clinical course was complicated by development of constrictive pericarditis for which he underwent surgical pericardiectomy. He received a total of 7 weeks of intravenously administered antibiotics with complete clinical recovery.ConclusionsAcute purulent bacterial pericarditis, although rare, should always be kept in mind as a possible cause of pericarditis. Early recognition and prompt intervention are important for a successful outcome.

Surgical Management of Massive Pericardial Effusion and Predictors for Development of Constrictive Pericarditis in a Resource Limited Setting

Background. The diagnosis and treatment of massive pericardial effusion and cardiac tamponade have evolved over the years with a tendency towards a more comprehensive diagnostic workup and less traumatic intervention. Method. We reviewed and analysed the data of 32 consecutive patients who underwent surgery on account of massive pericardial effusion and cardiac tamponade in a semiurban university hospital in Nigeria from February 2010 to February 2016. Results. The majority of patients (34.4%) were between 31 and 40 years. Fourteen patients (43.8%) presented with clinical and echocardiographic feature of cardiac tamponade. The majority of patients (59.4%) presented with haemorrhagic pericardial effusion and the average volume of fluid drained intraoperatively was 846 mL ± 67 mL. Pericardium was thickened in 50% of cases. Subxiphoid pericardiostomy was performed under local anaesthesia in 28 cases. No postoperative recurrence was observed; however 5 patients developed features of constrictive pericarditis. The relationship between pericardial thickness and development of pericardial constriction was statistically significant (p = 0.004). Conclusion. Subxiphoid pericardiostomy is a very effective way of treating massive pericardial effusion. Removing tube after adequate drainage (50 mL/day) and treatment of primary pathology are key to preventing recurrence. There is also a need to follow up patients to detect pericardial constriction especially those with thickened pericardium.

Clinical presentation and long-term follow-up of perimyocarditis

The natural history of perimyocarditis (PMY) is not yet completely known. We aimed to analyse the clinical laboratory data of PMY at diagnosis and during follow-up, in order to assess the natural history and prognostic stratification of the disease (including different aetiology). We enrolled 62 consecutive patients (men 79%, aged 38 ± 18 years) with PMY (84% idiopathic, 8% autoimmune, 8% infective) from August 2002 to July 2010. The diagnosis has been made according to clinical and laboratory data (significant increase of troponin I in all patients). After at least 1 year (mean follow-up: 1635 ± 298 days), 59 patients (95%) had available data. Chest pain was present in 59 patients (95%), flu-like syndrome in 36 (58%) and pericardial rubs in 15 (24%). None of the patients showed heart failure at presentation. At admission, eight patients (13%) presented mild-moderate left ventricular systolic dysfunction, 13 (22%) showed wall motion abnormalities, and 10 (17%) showed mild pericardial effusion. At 1 year no patients died, developed heart failure or showed abnormal echocardiogram. NSAIDs were the first choice therapy in 61 (98%) patients with clinical resolution in 58 (95%) of them. Seven patients (12%) experienced intermittent recurrences without development of constrictive pericarditis or heart failure. This study underlines the benign mid- to long-term outcome of PMY regardless of clinical laboratory characteristics at presentation, different aetiology and possibility of relapses; minimizing the role of endomyocardial biopsy in these specific patients.

Medium-Term Echocardiographic Follow-up of Systolic and Diastolic Left Ventricular Abnormalities After Surgical Treatment of Subacute Rupture

Subacute rupture of the left ventricular free wall is a complication that occurs during the acute phase of a myocardial infarction. The subacute presentation makes surgical management possible. However, it is not known whether either pericardial manipulation or the use of pericardial patches influences left ventricular function over the medium term. Our aim was to monitor changes in left ventricular function and the development of constrictive pericarditis over the medium term in patients who had been treated surgically for subacute rupture of the left ventricle. Eleven patients with subacute rupture underwent surgery, of whom six were followed up over the medium term. A modest improvement in left ventricular systolic function was observed and there was no evidence of constrictive pericarditis. In conclusion, the surgical approach appears to be safe over the medium term and had no influence on left ventricular function. Nor did it lead to the development of constrictive pericarditis.

Large pericardial effusions of inflammatory origin in childhood.

Our aim was to review the clinical records from children with large pericardial effusions of inflammatory origin presenting to a tertiary referral centre over the last 21 years, with emphasis on their clinical presentation, management and outcome. The common identifiable causes of pericardial effusion in children include prior cardiac surgery, bacterial pericarditis, malignancy, and connective tissue disorders. In a significant number of children, however, despite extensive investigation, it is not possible to identify a clear aetiology. A viral cause is often considered, though rarely confirmed. The clinical course of such large idiopathic pericardial effusions in children has not been extensively reported. We reviewed retrospectively the records of all patients seen between 1981 and 2001 with large pericardial effusions of inflammatory origin requiring drainage, excluding the effusions related to cardiac surgery or malignancy. We found 31 patients fulfilling our criterions for study. They could be divided into three groups, with 15 patients having no specific identifiable aetiology despite extensive investigation, 12 patients having evidence of bacterial pericarditis, and four with a probable immunologic disorder. Fever was present in only eight patients (53%) in the idiopathic group. All patients in the other groups had fever. Except for fever and the resultant tachycardia, it was not possible to distinguish on clinical grounds, nor on the presence or otherwise of cardiac tamponade, between those with idiopathic aetiology and those with bacterial infection. Of the patients with presumed bacterial pericarditis, five (42%) had both positive blood and pericardial fluid cultures, three (25%) had positive blood cultures, while a further three patients (25%) had only positive pericardial fluid cultures. All patients required drainage of the pericardial effusion, either under echocardiographic guidance or surgically. None of the patients died. The hospital stay was significantly shorter for those with idiopathic as opposed to bacterial pericarditis. Of those with an idiopathic aetiology, six required readmission due to recurrence of the pericardial effusion, with four patients requiring further surgical drainage. No patients required readmission with a bacterial or immunologic aetiology. No patient developed constrictive pericarditis after a median follow-up of 22 months. Patients with large idiopathic pericardial effusion had relatively few constitutional symptoms as compared with their gross echocardiographic findings. Those with bacterial pericarditis had more urgent need for treatment. Patients with pericardial effusion of inflammatory origin, when treated appropriately, had an excellent outcome with no mortality or development of constrictive pericarditis.

Intrapericardial echogenic images and development of constrictive pericarditis in patients with pericardial effusion

Intrapericardial echogenic images and development of constrictive pericarditis in patients with pericardial effusion

Pericardial injury by antibacterial irrigants

We injected antibacterial solutions into rabbit pericardium to investigate tissue injury. Povidone-iodine was the only irrigant found to cause substantial damage. These data lend experimental support to recent clinical observations that suggest a causal relation between pericardial irrigation with povidone-iodine and the later development of constrictive pericarditis.

Constrictive pericarditis in childhood due to mediastinal irradiation.

Between 1955 and 1972, eight children receiving mediastinal irradiation for intrathoracic malignancy developed constrictive pericarditis. Six of these followed irradiation for Hodgkin's disease and represent 7% of 86 children receiving irradiation for that disease. In patients with Hodgkin's disease, the development of constrictive pericarditis was related to the dose of radiation and the use of orthovoltage technique. Constrictive pericarditis has not yet developed among the 44 children radiated by supravoltage technique. Symptoms of constrictive pericarditis occurred an average of 15 months (4/12 to 3 2/12 years) after irradiation and were preceded in five of the eight patients by acute pericarditis. Prominent clinical findings included dyspnea, Kussmaul sign, pulsus paradoxicus, hepatomegaly, cardiomegaly and electrocardiographic evidence of low QRS voltages with ST-T wave changes. Pericardiectomy was performed in six patients and resulted in immediate but only transient symptomatic relief. There was no operative mortality. Death occurred in six of the eight patients (1 5/12 to 6 6/12 years following irradiation) due to cardiac disease in three, progression of the malignancy in two and infection in one. In addition to constrictive pericarditis, extensive myocardial fibrosis and involvement of the antero-lateral papillary muscle and chordae tendineae of the mitral valve were demonstrated at postmortem examination. These factors may explain the progression of cardiac disease despite an initial symptomatic improvement following pericardiectomy.

Acute nonspecific pericarditis complicated by the development of constrictive pericarditis: Two case reports

The literature is reviewed, and 2 cases of constrictive pericarditis after acute non-specific pericarditis are presented. Constriction occurred at approximately 8 and 6 1 2 weeks, with pericardiectomy at 13 and 10 1 2 weeks, respectively. The question is raised whether the disease is as rare as was previously believed.

Chronic idiopathic pericardial effusion: with special reference to the development of constrictive pericarditis.

Chronic idiopathic pericardial effusion is an unusual condition that causes severe congestive heart failure and may be an early stage in the development of constrictive pericarditis. A case is reported and some other cases from the literature are reviewed in order to present the clinical features and treatment of this condition.

Aspiration treatment of cardiac tamponade.

Opinion differs among surgeons of wide experience on the management of cardiac tamponade. Although pericardicentesis was suggested as early as 1649, 23 only during the last two decades has it been widely adopted. The value of aspiration has been emphasized by Bigger, Blalock, Elkin, Cooley, and others, 4-6,9,12,15,20,22 and this therapeutic measure is now generally accepted as an adjunct to the treatment of cardiac tamponade. Some surgeons 14,17 feel that, although aspiration may be lifesaving, a thoracotomy should be performed in almost all cases to allow closure of the wound in the myocardium and complete evacuation of the blood and clots from the pericardium. These surgeons contend that residual blood and clots may result in the development of constrictive pericarditis. In addition, attention is called to the possibility of cardiac aneurysm developing from failure to suture the myocardial wound. The treatment of cardiac wounds in this hospital prior to 1940