BACKGROUND: Constrictive pericarditis is a rare and disabling disease that can result in chronic fibrous thickening of the pericardium. Prompt treatment of constrictive pericarditis is necessary to limit morbidity and mortality. METHODS: We analyzed the clinical details of 51 constrictive pericarditis patients who underwent surgery from January 2005 to December 2010 at our center. RESULTS: Of the patients, 33 (65%) had tuberculous constrictive pericarditis, 13 (25%) had idiopathic pericarditis, 3 (6%) had previous cardiac surgery, and 1 (2%) had connective tissue disease. All patients underwent total pericardiectomy by midline sternotomy. The in-hospital mortality rate was 3.9% (2 of 51 patients). The cause of death was severe low cardiac output syndrome in 1 patient and acute renal failure in the other patient. There were 2 cases of recurrent constrictive pericarditis after discharge. The actuarial 1-year survival rate was 93.7%. One-year follow-up revealed that an initial higher erythrocyte sedimentation rate, abnormal creatinine value, postoperative low output syndrome, and pleural effusion were all associated with increased mortality. CONCLUSIONS: Rapid diagnosis and treatment of constrictive pericarditis are crucial to reduce mortality and morbidity. Pericardiectomy should be performed early after diagnosis, in order to prevent chronic illness. After surgery, inotropes, diuretics, salt restriction, and nutrition supply are also critical to improve the prognosis. The inflammation marker erythrocyte sedimentation rate should be evaluated during follow-up.
BACKGROUND:Constrictive pericarditis is a rare and disabling disease that can result in chronic fibrous thickening of the pericardium. Prompt treatment of constrictive pericarditis is necessary to limit morbidity and mortality. METHODS: We analyzed the clinical details of 51 constrictive pericarditispatients who underwent surgery from January 2005 to December 2010 at our center. RESULTS: Of the patients, 33 (65%) had tuberculous constrictive pericarditis, 13 (25%) had idiopathic pericarditis, 3 (6%) had previous cardiac surgery, and 1 (2%) had connective tissue disease. All patients underwent total pericardiectomy by midline sternotomy. The in-hospital mortality rate was 3.9% (2 of 51 patients). The cause of death was severe low cardiac output syndrome in 1 patient and acute renal failure in the other patient. There were 2 cases of recurrent constrictive pericarditis after discharge. The actuarial 1-year survival rate was 93.7%. One-year follow-up revealed that an initial higher erythrocyte sedimentation rate, abnormal creatinine value, postoperative low output syndrome, and pleural effusion were all associated with increased mortality. CONCLUSIONS: Rapid diagnosis and treatment of constrictive pericarditis are crucial to reduce mortality and morbidity. Pericardiectomy should be performed early after diagnosis, in order to prevent chronic illness. After surgery, inotropes, diuretics, salt restriction, and nutrition supply are also critical to improve the prognosis. The inflammation marker erythrocyte sedimentation rate should be evaluated during follow-up.
Authors: J J Brugts; A Constantinescu; A P Kappetein; S W E van de Poll; K Caliskan; O C Manintveld Journal: Neth Heart J Date: 2014-12 Impact factor: 2.380