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Huang JB, Lu CC, Wen ZK. Pericardiectomy with routine cardiopulmonary bypass: a multicenter, randomized controlled trial. Trials 2025; 26:138. [PMID: 40269976 PMCID: PMC12020316 DOI: 10.1186/s13063-025-08843-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Accepted: 04/15/2025] [Indexed: 04/25/2025] Open
Abstract
Constrictive pericarditis is a result of chronic inflammation characterized by thickening and calcification of pericardial fibers, impaired diastolic filling, reduced cardiac output, and ultimately heart failure. The main objective of this multicenter trial is to evaluate whether conventional extracorporeal circulation pericardial resection has a better prognosis than pericardial resection without extracorporeal circulation. This study is a multicenter, randomized controlled, evaluator blinded, parallel group study with an advantageous framework. A total of 436 participants with constrictive pericarditis will be randomly assigned to either the extracorporeal circulation pericardial resection group or the non-extracorporeal circulation pericardial clearance group in a 1:1 ratio using a computer. Incomplete pericardial detachment is associated with low cardiac output syndrome after pericardial resection. The causes of low cardiac output syndrome are related to incomplete resection of thickened pericardium, unsatisfactory relief of left ventricular compression, excessive ventricular dilation after pericardial dissection, myocardial weakness, and heart failure. The relief of left ventricular compression is crucial for the postoperative recovery of cardiac function.
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Affiliation(s)
- Jing-Bin Huang
- Department of Cardiothoracic Surgery, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan Road, Nanning, Guangxi, 530021, China.
| | - Chang-Chao Lu
- Department of Cardiothoracic Surgery, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan Road, Nanning, Guangxi, 530021, China
| | - Zhao-Ke Wen
- Department of Cardiothoracic Surgery, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan Road, Nanning, Guangxi, 530021, China
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Chao CJ, Luis SA, Arsanjani R, Oh JK. Applications of Artificial Intelligence in Constrictive Pericarditis: A Short Literature Review. Curr Cardiol Rep 2025; 27:70. [PMID: 40067491 DOI: 10.1007/s11886-025-02222-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2025] [Indexed: 05/13/2025]
Abstract
PURPOSE OF REVIEW Constrictive pericarditis (CP) is a potentially curable condition characterized by the thickening, scarring, and calcification of the pericardium. A comprehensive approach, including clinical evaluations and imaging techniques such as echocardiography, computed tomography, and magnetic resonance imaging, is essential for timely diagnosis and intervention to prevent chronic complications and enhance patient outcomes. However, the rarity of CP and the specialized expertise required present challenges in diagnosis. RECENT FINDINGS Emerging artificial intelligence applications show promise in enhancing clinical decision-making and improving outcomes. Studies utilizing cognitive machine learning and deep learning algorithms (ResNet50) achieved an AUC above 0.95 in distinguishing CP from restrictive cardiomyopathy. However, generalization and interpretability issues remain, and the development of AI applications for CP is still nascent due to challenges in obtaining large, high-quality echocardiographic datasets. Future research should evaluate the effectiveness of these models in diverse clinical scenarios, employing comprehensive echocardiography, point-of-care ultrasound, and other modalities to improve CP detection, individualized risk assessment, and treatment planning, ultimately enhancing patient prognosis.
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Affiliation(s)
| | | | | | - Jae K Oh
- Mayo Clinic Rochester, Minnesota, USA
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Leivaditis V, Ayed S, Özsoy E, Lausberg H, Papatriantafyllou A, Mulita F, Baikoussis NG, Windmüller V, Dahm M. From Infection to Constriction: Successful Surgical Resolution of Constrictive Pericarditis Following Purulent Pericarditis. Cureus 2025; 17:e81449. [PMID: 40303527 PMCID: PMC12038764 DOI: 10.7759/cureus.81449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2025] [Indexed: 05/02/2025] Open
Abstract
Constrictive pericarditis (CP) is a rare but serious condition characterized by pericardial fibrosis and impaired ventricular filling, often resulting in progressive heart failure. Infectious pericarditis, particularly purulent forms, is a severe etiology requiring early recognition and intervention. A 64-year-old male with a history of Staphylococcus aureus pericarditis presented with worsening dyspnea and signs of right heart failure. Imaging revealed a thickened, fibrotic pericardium with mild effusion, while cardiac catheterization confirmed CP with equalized diastolic pressures and a dip-plateau phenomenon. Given his clinical deterioration, he underwent subtotal pericardiectomy with pericardial reconstruction. Intraoperatively, severe adhesions were noted, necessitating extensive pericardial resection. The patient showed rapid postoperative improvement, with a resolution of heart failure symptoms and normalization of right ventricular function. This case highlights the importance of timely diagnosis and surgical intervention in CP following infectious pericarditis. Pericardiectomy remains the definitive treatment, with early recognition being key to optimizing patient outcomes.
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Affiliation(s)
- Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, Kaiserslautern, DEU
| | - Sofien Ayed
- Department of Cardiology, Westpfalz-Klinikum, Kaiserslautern, DEU
| | - Ece Özsoy
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, Kaiserslautern, DEU
| | - Henning Lausberg
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, Kaiserslautern, DEU
| | | | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, GRC
- Department of Surgery, General Hospital of Eastern Achaia - Unit of Aigio, Aigio, GRC
| | | | | | - Manfred Dahm
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, Kaiserslautern, DEU
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Samim D, Muula G, Banholzer N, Chibomba D, Xulu S, Bolton C, Evans D, Perrig L, De Marchi S, Günther G, Egger M, Pilgrim T, Fenner L, IeDEA Southern Africa (IeDEA-SA). Cardiovascular Involvement in Tuberculosis Patients Treated in Southern Africa. JACC. ADVANCES 2025; 4:101427. [PMID: 39720579 PMCID: PMC11667022 DOI: 10.1016/j.jacadv.2024.101427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 10/04/2024] [Accepted: 10/24/2024] [Indexed: 12/26/2024]
Abstract
Background Tuberculosis (TB) is the leading cause of death among people with HIV and a major global health challenge. Subclinical cardiovascular manifestations of TB are poorly documented in high TB and HIV burden countries. Objectives The purpose of this study was to quantify the prevalence of cardiovascular involvement in TB patients and investigate changes after completion of anti-TB treatment. Methods HIV-positive and HIV-negative patients diagnosed with pulmonary TB between October 2022 and November 2023 were enrolled from 2 tertiary care hospitals in Zambia and South Africa. Standardized transthoracic echocardiography (TTE) was conducted at TB diagnosis and after 6 months of anti-TB treatment. Cross-sectional and longitudinal analyses assessed pericardial effusion, thickening, or calcification, with and without signs of pericardial constriction. Results A total of 286 TB patients (218 [76%] men, 109 [38%] people with HIV, median age 35 years) underwent TTE at TB diagnosis, of whom 105 participants had a second TTE after completion of treatment. At TB diagnosis, 134 (47%) had pericardial effusions, 86 (30%) thickening, 7 (2%) calcifications, 103 (42%) signs of constriction, and 13 (12%) had definite diagnosis of constriction. After TB treatment, pericardial effusions (47% vs 16%, P < 0.001) and pericardial thickenings (30% vs 15%, P = 0.002) became less prevalent. Pericardial calcifications (2% vs 1%, P = 0.4), signs of constrictions (42% vs 38%, P = 0.4), and definite diagnosis of constriction (12% vs 14%, P = 0.8) were similar. Conclusions Cardiac involvement is frequent in newly diagnosed TB patients. Early pericardial changes may be reversed with anti-TB treatment. Echocardiographic screening facilitates early detection and timely management of cardiovascular involvement in TB patients.
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Affiliation(s)
- Daryoush Samim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Guy Muula
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Nicolas Banholzer
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Douglas Chibomba
- University Teaching Hospital, Department of Internal Medicine, Lusaka, Zambia
| | - Sihle Xulu
- Department of Cardiology, Helen Joseph Clinic, Johannesburg, Republic of South Africa
| | - Carolyn Bolton
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Denise Evans
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa Perrig
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Stefano De Marchi
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gunar Günther
- Department of Pulmonology and Allergology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, Republic of South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Fenner
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - IeDEA Southern Africa (IeDEA-SA)
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- University Teaching Hospital, Department of Internal Medicine, Lusaka, Zambia
- Department of Cardiology, Helen Joseph Clinic, Johannesburg, Republic of South Africa
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Pulmonology and Allergology, Inselspital, University Hospital of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, Republic of South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Lee HN, Hyun J, Jung SH, Kim JB, Lee JE, Yang DH, Kang JW, Koo HJ. CT-derived myocardial strain measurement in patients with chronic constrictive pericarditis. J Cardiovasc Comput Tomogr 2025; 19:48-55. [PMID: 39406562 DOI: 10.1016/j.jcct.2024.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 10/01/2024] [Accepted: 10/06/2024] [Indexed: 02/16/2025]
Abstract
BACKGROUND We aimed to compare computed tomography (CT)-derived myocardial strain between patients with constrictive pericarditis (CP) and a matched healthy control group and to identify factors associated with clinical outcomes after pericardiectomy. METHODS This retrospective study included 65 patients with CP (mean age: 58.9 ± 8.0 years) and 65 healthy individuals (mean age: 58.0 ± 6.5 years) who underwent multiphase cardiac CT. The type of CP was classified as calcified CP or fibrotic CP. CT-derived strains from four cardiac chambers were compared between the CP and control groups, as well as between different types of CP. Clinical and CT-derived factors associated with adverse outcomes were identified using Cox regression analysis. RESULTS Compared with the control group, the CP group showed significantly lower values of left atrium (LA) reservoir strain (15.7 % vs. 27.4 %), right atrium (RA) reservoir strain (15.1 % vs. 27.0 %), left ventricle (LV) global longitudinal strain (GLS) (-17.0 % vs. -19.5 %), and right ventricle free wall longitudinal strain (-21.1 % vs. -25.9 %) (all p < 0.001). Biatrial reservoir strains and LV GLS were significantly lower in those with calcified CP compared to those with fibrotic CP. LA reservoir strain (hazard ratio, 0.91-95 % confidence interval, 0.86-0.96- p = 0.001) was an independent prognostic factor for adverse events in patients with CP. CONCLUSION Cardiac strain differences in CP were predominantly observed in the LA and RA compared to the healthy control group. Biatrial reservoir strains were specifically impaired in those with calcified CP than in those with fibrotic CP. LA reservoir strain was associated with prognosis in patients with CP following pericardiectomy.
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Affiliation(s)
- Han Na Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Junho Hyun
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jun Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jong En Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Kim B, Lee HS, Ahn Y, Jung SH, Kim JB, Kim DH, Yang DH, Kang JW, Koo HJ. Impact of preoperative clinical and imaging factors on post-pericardiectomy outcomes in chronic constrictive pericarditis patients. Sci Rep 2024; 14:28145. [PMID: 39548156 PMCID: PMC11568208 DOI: 10.1038/s41598-024-78923-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 11/05/2024] [Indexed: 11/17/2024] Open
Abstract
The present study was designed to identify the preoperative clinical and imaging findings influencing adverse clinical outcomes in patients with chronic constrictive pericarditis after pericardiectomy. Patients with constrictive pericarditis who underwent pericardiectomy between January 2009 and September 2023 were retrospectively analyzed. Preoperative evaluations included assessments of clinical symptoms, comorbidities, laboratory tests, cardiac computed tomography (CT), and transthoracic echocardiography. The volume of pericardial calcifications was quantified on calcium scoring CT. Adverse clinical events were defined as cardiovascular death or hospitalization due to cardiac causes, and all-cause mortality was assessed. Univariable and multivariable Cox proportional hazard model analysis were performed to find factors associated with adverse clinical events. Among the 91 patients with available preoperative CT scans, 26 (28.6%) experienced adverse clinical events after pericardiectomy, with 19 (20.9%) experiencing cardiovascular deaths. On multivariable Cox analysis, larger pericardial calcium volume hazard ratio [HR], 1.004 (95% confidence interval [CI], 1.001-1.006) per 1cm3 increase; p = 0.005), higher E/E' ratio (HR, 1.059, 95% CI, 1.015-1.105, p = 0.008), and lower albumin level (HR, 0.476, 95% CI, 0.229-0.986, p = 0.046) were significant factors associated with the adverse clinical events after pericardiectomy. The amount of pericardial calcification could be associated with the efficacy of pericardiectomy and potentially have implications for postoperative outcomes. Additionally, a high E/E ratio on echocardiography is indicative of unfavorable postoperative prognosis.
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Affiliation(s)
- Byungsoo Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 88, Seoul, 05505, Korea
| | - Hyun Seo Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 88, Seoul, 05505, Korea
| | - Yura Ahn
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 88, Seoul, 05505, Korea
| | - Sung Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae-Hee Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 88, Seoul, 05505, Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 88, Seoul, 05505, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 88, Seoul, 05505, Korea.
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Nugraha YK, Maimunah U. Perioperative management of constrictive pericarditis with cardiac cirrhosis: A case report. Int J Surg Case Rep 2024; 120:109843. [PMID: 38848659 PMCID: PMC11192800 DOI: 10.1016/j.ijscr.2024.109843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/26/2024] [Accepted: 05/30/2024] [Indexed: 06/09/2024] Open
Abstract
INTRODUCTION The interactions between the heart and liver have been known for a long time, pericarditis constrictive could cause congestive hepatopathy via right-sided heart failure. Liver cirrhosis correlates with a high risk of mortality so perioperative management greatly influences outcomes. CASE PRESENTATION An Indonesian man, 50 years old, complained of breath shortness. The patient had a history of pulmonary tuberculosis and was declared cured 30 years ago. The patient began experiencing fatigue 14 years ago, and the patient was diagnosed with constrictive pericarditis 5 years ago. Currently, the patient has an increased jugular venous pressure of 9 cmH2O and abnormal laboratory indicators, including a platelet count of 121,000/μL, albumin count of 3.41 g/L, direct bilirubin count of 0.7 mg/dL, total bilirubin count of 1.4 mg/dL, and INR of 1.4. Echocardiography revealed left ventricle hypertrophy, diastolic dysfunction, and right ventricle failure. Cardiac CT scan showed pericardial calcification. Abdominal ultrasound showed liver congestive and splenomegaly. Transient elastography showed severe fibrosis in liver and stiffness in spleen. The patient underwent pericardiectomy with CTP score of 6 and MELD of 12. The surgery was successful, and the complaint was reduced. The patient experienced an improvement in his condition and able to carry out activities well after 2 years post-surgery. DISCUSSION The patient has no contraindications to pericardiectomy, CTP class A (5-6) and MELD score <13.5 has a low risk of mortality. CONCLUSION CTP and MELD scores predict life expectancy in post-surgery cardiac cirrhosis patients.
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Affiliation(s)
- Yudha Klahan Nugraha
- Study Program of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Ummi Maimunah
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
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Santaularia-Tomas M, Sanchez-Felix E, Santos-Zaldivar K, Grosjean-Alvarez A, Mendez-Dominguez N. Pericardial Calcification: An Uncommon Case with Intraventricular Extension. Tomography 2024; 10:1024-1030. [PMID: 39058048 PMCID: PMC11281272 DOI: 10.3390/tomography10070076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/19/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
An 80-year-old man presented to the cardiology outpatient clinic due to shortness of breath. His past medical history included alcohol intake, hypertension, inferior wall myocardial infarction (five years ago), an ischemic stroke, and permanent atrial fibrillation (diagnosed three years before the current examination). A physical exam revealed a decreased intensity of S1 and S2, irregular rate and rhythm, and no murmurs nor friction rub. X-rays, Computed Tomography, and echocardiography exhibited pericardial calcification, involving mostly the inferior wall and protruding into the left ventricle. A diagnosis of constrictive pericarditis due to pericardial calcification was established and considered idiopathic. Even when it may be related to ischemic heart disease, post-infarction pericarditis could explain how the calcification extended to adjacent territory perfused by the circumflex coronary artery. Combined imaging studies were crucial not only for identifying calcium deposits in the pericardium but also in assessing a patient inherently prone to co-existing and exacerbating conditions. Even though pericardiectomy allows for removal of the clinical manifestations of congestive pericarditis in the most symptomatic patients with pericardial calcification, among patients like ours, with tolerable symptoms, cardiologists should discuss the therapeutic options considering the patient's choices, potentially including a rehabilitation plan as part of non-pharmacological management.
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Affiliation(s)
- Miguel Santaularia-Tomas
- Subdirección de Enseñanza e Investigación, Hospital Regional de Alta Especialidad de la Peninsula de Yucatan IMSS-BIENESTAR, Merida 97130, Mexico; (E.S.-F.); (K.S.-Z.)
| | - Ely Sanchez-Felix
- Subdirección de Enseñanza e Investigación, Hospital Regional de Alta Especialidad de la Peninsula de Yucatan IMSS-BIENESTAR, Merida 97130, Mexico; (E.S.-F.); (K.S.-Z.)
| | - Kassandra Santos-Zaldivar
- Subdirección de Enseñanza e Investigación, Hospital Regional de Alta Especialidad de la Peninsula de Yucatan IMSS-BIENESTAR, Merida 97130, Mexico; (E.S.-F.); (K.S.-Z.)
| | | | - Nina Mendez-Dominguez
- Subdirección de Enseñanza e Investigación, Hospital Regional de Alta Especialidad de la Peninsula de Yucatan IMSS-BIENESTAR, Merida 97130, Mexico; (E.S.-F.); (K.S.-Z.)
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Yeşiltaş MA, Kavala AA, Turkyilmaz S, Kuserli Y, Türkyilmaz G, Toz H, Özen C. Surgical treatment of constrictive pericarditis at a single center: 10 years of experience. Acta Chir Belg 2024; 124:107-113. [PMID: 37232347 DOI: 10.1080/00015458.2023.2216377] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Constrictive pericarditis (CP) is a pericardial disease characterized by the pericardium becoming calcified or fibrotic as a result of chronic inflammation, which impairs diastolic filling by compressing the cardiac chambers. Pericardiectomy is a promising surgical option for treating CP. In this study, we reviewed over 10 years of preoperative, perioperative, and short-term postoperative follow-ups of patients who underwent pericardiectomy for constrictive pericarditis at our clinic. METHODS Between January 2012 and May 2022, 44 patients were diagnosed with constrictive pericarditis. Twenty-six patients underwent pericardiectomy for CP. Median sternotomy is the surgical approach of choice because it provides easy access for complete pericardiectomy. RESULTS The patient median age was 56 (min: 32, max: 71), and 22 out of 26 patients (84.6%) were male. Twenty-one patients (80.8%) complained of dyspnea, which was the most common reason for admission. Twenty-four patients (92.3%) were scheduled for elective surgery. Cardiopulmonary bypass (CPB) was used during the procedure in six patients (23%). The duration of intensive care stay was two days (min: 1, max: 11), and the total hospitalization was six days (min: 4, max: 21). No in-hospital mortality was observed. CONCLUSION The median sternotomy approach provides a critical advantage in terms of performing a complete pericardiectomy. Although CP is a chronic condition, early diagnosis and planning of pericardiectomy before irreversible deterioration of cardiac function leads to a notable reduction in mortality and morbidity.
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Affiliation(s)
- Mehmet Ali Yeşiltaş
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ali Aycan Kavala
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Saygin Turkyilmaz
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Kuserli
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Gülsüm Türkyilmaz
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Hasan Toz
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Can Özen
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Li B, Dong C, Pan G, Liu R, Tong M, Xu J, Liu S. Outcomes and Risk Factors Associated with Pericardiectomy in Patients with Constrictive Pericarditis: A Retrospective Study from China. Ann Thorac Cardiovasc Surg 2024; 30:24-00036. [PMID: 38811208 PMCID: PMC11163141 DOI: 10.5761/atcs.oa.24-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/28/2024] [Indexed: 05/31/2024] Open
Abstract
PURPOSE Pericardiectomy is the definitive treatment option for constrictive pericarditis and is associated with a high prevalence of morbidity and mortality. However, information on the associated outcomes and risk factors is limited. We aimed to report the mid-term outcomes of pericardiectomy from a single center in China. METHODS We retrospectively reviewed data collected from patients who underwent pericardiectomy at our institute from April 2018 to January 2023. RESULTS Eighty-six consecutive patients (average age, 46.1 ± 14.7 years; 68.6 men) underwent pericardiectomy through midline sternotomy. The most common etiology was idiopathic (n = 60, 69.8%), and 82 patients (95.3%) were in the New York Heart Association function class III/IV. In all, 32 (37.2%) patients underwent redo sternotomies, 36 (41.9%) underwent a concomitant procedure, and 39 (45.3%) required cardiopulmonary bypass. The 30-day mortality rate was 5.8%, and the 1-year and 5-year survival rates were 88.3% and 83.5%, respectively. Multivariable analysis revealed that preoperative mitral insufficiency (MI) ≥moderate (hazard ratio [HR], 6.435; 95% confidence interval [CI] [1.655-25.009]; p = 0.007) and partial pericardiectomy (HR, 11.410; 95% CI [3.052-42.663]; p = 0.000) were associated with increased 5-year mortality. CONCLUSION Pericardiectomy remains a safe operation for constrictive pericarditis with optimal mid-term outcomes.
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Affiliation(s)
- Bin Li
- Cardiac Surgery Department, Peking University International Hospital, Beijing, China
| | - Chao Dong
- Cardiac Surgery Department, Peking University International Hospital, Beijing, China
| | - Guangyu Pan
- Cardiac Surgery Department, Peking University International Hospital, Beijing, China
| | - Ruofan Liu
- Cardiac Surgery Department, Peking University International Hospital, Beijing, China
| | - Minghui Tong
- Cardiac Surgery Department, Peking University International Hospital, Beijing, China
| | - Jianping Xu
- Cardiac Surgery Department, Peking University International Hospital, Beijing, China
| | - Shen Liu
- Cardiac Surgery Department, Peking University International Hospital, Beijing, China
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Lloyd JW, Anavekar NS, Oh JK, Miranda WR. Multimodality Imaging in Differentiating Constrictive Pericarditis From Restrictive Cardiomyopathy: A Comprehensive Overview for Clinicians and Imagers. J Am Soc Echocardiogr 2023; 36:1254-1265. [PMID: 37619909 DOI: 10.1016/j.echo.2023.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/27/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
In the evaluation of heart failure, 2 differential diagnostic considerations include constrictive pericarditis and restrictive cardiomyopathy. The often outwardly similar clinical presentation of these 2 pathologic entities routinely renders their clinical distinction difficult. Consequently, initial assessment requires a keen understanding of their separate pathophysiology, epidemiology, and hemodynamic effects. Following a detailed clinical evaluation, further assessment initially rests on comprehensive echocardiographic investigation, including detailed Doppler evaluation. With the combination of mitral inflow characterization, tissue Doppler assessment, and hepatic vein interrogation, initial differentiation of constrictive pericarditis and restrictive cardiomyopathy is often possible with high sensitivity and specificity. In conjunction with a compatible clinical presentation, successful differentiation enables both an accurate diagnosis and subsequent targeted management. In certain cases, however, the diagnosis remains unclear despite echocardiographic assessment, and additional evaluation is required. With advances in noninvasive tools, such evaluation can often continue in a stepwise, algorithmic fashion noninvasively, including both cross-sectional and nuclear imaging. Should this additional evaluation itself prove insufficient, invasive assessment with appropriate expertise may ultimately be necessary.
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Affiliation(s)
- James W Lloyd
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nandan S Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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12
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Korkchi N, Ngo L, Fong KM, Chaudhuri A, Godbolt D, Ranasinghe I. Pericardial infiltration and constriction due to cardiac actinomycosis-case report. Eur Heart J Case Rep 2023; 7:ytad510. [PMID: 38077408 PMCID: PMC10702456 DOI: 10.1093/ehjcr/ytad510] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/26/2023] [Accepted: 10/10/2023] [Indexed: 11/29/2024]
Abstract
BACKGROUND Constrictive pericarditis associated with actinomycosis infection is a rare and challenging diagnosis due to its insidious manifestation. We describe the successful treatment of pericardial infiltration and constriction due to actinomycosis. CASE SUMMARY A 50-year-old Aboriginal man presented with insidious onset of fatigue, dyspnoea, pleuritic chest pain, fever, drenching sweats, severe exercise intolerance to 50 m, and recurrent itchy skin lesions over 8 months. Prior investigations, including serial fluorodeoxyglucose (FDG)-Positron emission tomography scans, found a progressively enlarging, metabolically active anterior mediastinal mass with two biopsies on separate occasions showing no malignancy, granulomas, tuberculosis, or other pathology. Screening for infective, autoimmune, and connective tissue disease was negative. A transthoracic echocardiogram (TTE) showed fibrinous pericarditis with extensive myocardial tethering and constrictive physiology confirmed on heart catheterization. A pericardial biopsy showed inflammatory tissue only. Biopsy of a skin lesion on the buttock showed abscess formation with Splendore Hoeppli phenomenon with Gram-positive and Grocott-positive filamentous bacteria suggestive of actinomyces, confirmed by 16S rRNA gene sequencing. He was diagnosed with cardiac actinomycosis, likely due to mediastinal infiltration from a lung infection, with haematogenous spread and treated with Penicillin G with adjunctive high-dose steroid therapy with resolution of symptoms and marked improvement in TTE features of constriction after 6 weeks. DISCUSSION Actinomycosis is an extremely rare cause of pericardial infiltration and constriction yet highly sensitive to penicillin, highlighting the importance of accurate diagnosis. Corticosteroids are a useful adjunct to prevent chronic constrictive pericarditis and to avoid the high morbidity and mortality associated with pericardiectomy.
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Affiliation(s)
- Niloufar Korkchi
- The Prince Charles Hospital, 627 Rode Road, Chermside, Brisbane, QLD 4032, Australia
| | - Linh Ngo
- The Prince Charles Hospital, 627 Rode Road, Chermside, Brisbane, QLD 4032, Australia
- Greater Brisbane Clinical School, The University of Queensland, Brisbane, QLD, Australia
| | - Kwun M Fong
- The Prince Charles Hospital, 627 Rode Road, Chermside, Brisbane, QLD 4032, Australia
- University of Queensland Thoracic Research Centre, QLD, Australia
| | - Alex Chaudhuri
- The Prince Charles Hospital, 627 Rode Road, Chermside, Brisbane, QLD 4032, Australia
- University of Queensland school of medicine, Brisbane, QLD, Australia
| | - David Godbolt
- Department of Anatomical Pathology, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Isuru Ranasinghe
- The Prince Charles Hospital, 627 Rode Road, Chermside, Brisbane, QLD 4032, Australia
- Greater Brisbane Clinical School, The University of Queensland, Brisbane, QLD, Australia
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13
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Lee YH, Kim SM, Kim EK, Park SJ, Lee SC, Park SW, Jeong DS, Chang SA. Pattern of pericardial calcification determines mid-term postoperative outcomes after pericardiectomy in chronic constrictive pericarditis. Int J Cardiol 2023; 387:131133. [PMID: 37355240 DOI: 10.1016/j.ijcard.2023.131133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/30/2023] [Accepted: 06/20/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVES Although pericardiectomy is an effective treatment for constrictive pericarditis (CP), clinical outcomes are not always successful. Pericardial calcification is a unique finding in CP, although the amount and localization of calcification can vary. We investigated how the pattern and amount of pericardial calcification affect mid-term postoperative outcomes after pericardiectomy to treat CP. METHODS All patients of total pericardiectomy in our hospital from 2010 to 2020 were enrolled. Preoperative Computed tomography (CT) scans of 98 consecutive patients were available and analyzed. Medical records were reviewed retrospectively. Cardiovascular events were defined as cardiovascular death or hospitalization associated with a heart failure symptom, and all-cause events were defined as any event that required admission. CT scans were analyzed, and the volume and localization pattern of peri-calcification were determined. Pericardium calcium scores are presented using Agatston scores. RESULTS Of the 98 patients, 25 (25.5%) were hospitalized with heart failure symptoms after pericardiectomy. The median follow-up duration for all patients was 172 weeks. The group with a cardiovascular event had a lower calcium score than patients without an event. Multivariate Cox proportional analysis showed that high ln(calcium score+1) before pericardiectomy was a dependent predictor of cardiovascular event (hazard ratio, 0.90; p = 0.04) after pericardiectomy. When we set the cut-off value (ln(calcium score+1) = 7.22), there was a significant difference in cardiovascular events in the multivariate Cox proportional analysis (p = 0.04). CONCLUSION A low burden of pericardial calcification was associated with a high rate of mid-term clinical events after pericardiectomy to treat CP.
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Affiliation(s)
- Young-Hyun Lee
- Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Mok Kim
- Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Kyoung Kim
- Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-Ji Park
- Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Chol Lee
- Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Woo Park
- Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Seop Jeong
- Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
| | - Sung-A Chang
- Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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14
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Nakamura Y, Doi K, Fujii R, Ogura H, Umeda E, Kato T, Sakai O, Shimabukuro K. Postoperative constrictive pericarditis caused rupture of lymphatic collaterals: a rare etiology of chylothorax. GENERAL THORACIC AND CARDIOVASCULAR SURGERY CASES 2023; 2:81. [PMID: 39517060 PMCID: PMC11533690 DOI: 10.1186/s44215-023-00092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 07/18/2023] [Indexed: 11/16/2024]
Abstract
BACKGROUND Chylothorax after cardiovascular surgery is primarily caused by direct injury to the thoracic duct or its branches, and occurs in early postoperative period. In the present case, we describe a rare case of chylothorax manifesting three months after surgery secondary to constrictive pericarditis. CASE PRESENTATION A 71-year-old man underwent mitral valve replacement, tricuspid valve annuloplasty, and the maze procedure. He developed acute perioperative myocardial infarction on postoperative day one due to plaque rupture in the left anterior descending artery and underwent percutaneous coronary intervention. Although the patient was discharged on postoperative day 36, he required readmission on postoperative day 83 because of right side chylothorax associated with constrictive pericarditis. Lymphangiography revealed thoracic duct interruption and development of lymphatic collateral vessels via the right hilum. Single-photon emission computed tomography revealed abnormal tracer accumulation in the right hilum, suggesting a lymphatic leakage site. A catheter study indicated biventricular dip and plateau patterns with a reduced cardiac index (1.6 L/min/m2) and elevated central venous pressure (18 mmHg). Conservative treatment for chylothorax, including a low-fat diet and continuous drainage with chest tube, was unsuccessful. Drainage of chyle at approximately 500 mL/day continued. On hospitalization day 50, complete pericardiectomy via median sternotomy was performed because the patient's cardiac function deteriorated. The central venous pressure dramatically decreased, and the chylothorax gradually subsided. There was no recurrence of symptoms 1 year postoperatively. CONCLUSIONS Chylothorax associated with constrictive pericarditis subsequent to cardiac surgery is extremely rare. Although conservative management failed, the present case was successfully treated via pericardiectomy alone and did not require any additional precedures, such as thoracic duct ligation via a right thoracotomy.
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Affiliation(s)
- Yasuhito Nakamura
- Department of Cardiovascular Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Kiyoshi Doi
- Department of Cardiovascular Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan.
| | - Ryo Fujii
- Department of Cardiovascular Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Hiroki Ogura
- Department of Cardiovascular Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Etsuji Umeda
- Department of Cardiovascular Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Takayoshi Kato
- Department of Cardiovascular Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Osamu Sakai
- Department of Cardiovascular Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Katsuya Shimabukuro
- Department of Cardiovascular Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
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15
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Isidoro CA, Deniset JF. Pericardial Immune Cells and Their Evolving Role in Cardiovascular Pathophysiology. Can J Cardiol 2023; 39:1078-1089. [PMID: 37270165 DOI: 10.1016/j.cjca.2023.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/05/2023] Open
Abstract
The pericardium plays several homeostatic roles to support and maintain everyday cardiac function. Recent advances in techniques and experimental models have allowed for further exploration into the cellular contents of the pericardium itself. Of particular interest are the various immune cell populations present in the space within the pericardial fluid and fat. In contrast to immune cells of the comparable pleura, peritoneum and heart, pericardial immune cells appear to be distinct in their function and phenotype. Specifically, recent work has suggested these cells play critical roles in an array of pathophysiological conditions including myocardial infarction, pericarditis, and post-cardiac surgery complications. In this review, we spotlight the pericardial immune cells currently identified in mice and humans, the pathophysiological role of these cells, and the clinical significance of the immunocardiology axis in cardiovascular health.
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Affiliation(s)
- Carmina Albertine Isidoro
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Justin F Deniset
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada; Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada.
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16
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Li J, Li R, Cheng G, Lu C, Liu W, Sun D, Li X, Wang Z. A case series of constrictive pericarditis and suggested echocardiographic diagnostic criteria. J Int Med Res 2022; 50:3000605221134468. [PMID: 36345170 PMCID: PMC9647258 DOI: 10.1177/03000605221134468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/05/2022] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The diagnosis of constrictive pericarditis (CP) is challenging as there are currently no standard echocardiographic diagnostic criteria. In this retrospective case series, we analyzed and summarized the features of 25 patients with CP and proposed echocardiographic diagnostic criteria. It is hoped that the suggested criteria help professionals make decisions in their daily practice so that patients receive timely diagnosis and effective treatment. METHODS Twenty-five patients with CP were selected for this retrospective study. The clinical and echocardiographic imaging data were analyzed and summarized, and echocardiographic diagnostic criteria for CP were proposed. RESULTS The main clinical manifestations were fatigue, breathlessness, exertional dyspnea (88%), lower-limb edema (84%), hepatomegaly, and jugular vein filling (84%). Echocardiographic features comprised pericardial thickening (88%) and calcification (60%), pulmonary hypertension (52%), inferior vena cava dilation (80%), left and/or right atrial enlargement (100%), diastolic flattening of the left ventricular (LV) posterior wall (72%), septal shudder and bounce (64%), restrictive LV and right ventricular diastolic filling pattern (100%), early filling changes of mitral and tricuspid flow (80% and 60%, respectively), and mitral annulus reversus (73%). CONCLUSIONS Echocardiography is a simple and valuable examination for CP. The echocardiographic diagnostic criteria are valid and worth promoting.
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Affiliation(s)
- Junfang Li
- Department of Echocardiography, Qingdao University Affiliated
Hospital, Qingdao, China
| | - Rong Li
- Department of Echocardiography, Qingdao University Affiliated
Hospital, Qingdao, China
| | - Guangting Cheng
- Department of Ultrasonography, the Affiliated Qingdao Central
Hospital of Qingdao University, the Second Affiliated Hospital of Qingdao
University, Qingdao, China
| | - Changhong Lu
- Department of Heart Center, Qingdao Fuwai Cardiovascular
Hospital, Qingdao, China
| | - Weigang Liu
- Department of Echocardiography, Qingdao University Affiliated
Hospital, Qingdao, China
| | - Dongmei Sun
- Department of Echocardiography, Qingdao University Affiliated
Hospital, Qingdao, China
| | - Xue Li
- Department of Echocardiography, Qingdao University Affiliated
Hospital, Qingdao, China
| | - Zhibin Wang
- Department of Echocardiography, Qingdao University Affiliated
Hospital, Qingdao, China
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17
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Nagraj S, Peppas S, Rubianes Guerrero MG, Kokkinidis DG, Contreras-Yametti FI, Murthy S, Jorde UP. Cardiac risk stratification of the liver transplant candidate: A comprehensive review. World J Transplant 2022; 12:142-156. [PMID: 36051452 PMCID: PMC9331410 DOI: 10.5500/wjt.v12.i7.142] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/15/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular diseases (CVD) form a principal consideration in patients with end-stage liver disease (ESLD) undergoing evaluation for liver transplant (LT) with prognostic implications in the peri- and post-transplant periods. As the predominant etiology of ESLD continues to evolve, addressing CVD in these patients has become increasingly relevant. Likewise, as the number of LTs increase by the year, the proportion of older adults on the waiting list with competing comorbidities increase, and the demographics of LT candidates evolve with parallel increases in their CVD risk profiles. The primary goal of cardiac risk assessment is to preemptively reduce the risk of cardiovascular morbidity and mortality that may arise from hemodynamic stress in the peri- and post-transplant periods. The complex hemodynamics shared by ESLD patients in the pre-transplant period with adverse cardiovascular events occurring in only some of these recipients continue to challenge currently available guidelines and their uniform applicability. This review focusses on cardiac assessment of LT candidates in a stepwise manner with special emphasis on preoperative patient optimization. We hope that this will reinforce the importance of cardiovascular optimization prior to LT, prevent futile LT in those with advanced CVD beyond the stage of optimization, and thereby use the finite resources prudently.
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Affiliation(s)
- Sanjana Nagraj
- Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, New York City, NY 10461, United States
| | - Spyros Peppas
- Department of Gastroenterology, Athens Naval Hospital, Athens 115 21, Greece
| | | | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT 06510, United States
| | | | - Sandhya Murthy
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, NY 10467, United States
| | - Ulrich P Jorde
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, NY 10467, United States
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18
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Alabi FO, Alabi CO, Romero C, Bates J, Elton D. A 50-Year-Old Man With a History of Recurrent Exudative Right-Sided Pleural Effusion. Cureus 2022; 14:e26900. [PMID: 35983398 PMCID: PMC9376057 DOI: 10.7759/cureus.26900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/30/2022] Open
Abstract
In this case report, we describe a 50-year-old man who presented to our facility for a second opinion after a year-long history of recurrent and now persistent right-sided exudative pleural effusion. On review of previous records, negative findings were seen in microbiological studies, including acid-fast bacilli, cytology, flow cytometry, and pleural biopsy using video-assisted thoracoscopy. On transthoracic echocardiography performed during our evaluation, the expected respiratory variations across the mitral and tricuspid valves were not appreciated. This necessitated subsequent cardiac workup via magnetic resonance imaging, which showed a small pericardial fluid, thickened pericardium, and a septal bounce. The patient was surgically treated using a phrenic-to-phrenic pericardiectomy, following which his symptoms resolved completely. Pleural effusions occur in approximately 40-60% of patients with constrictive pericarditis, and despite the known association of pleural effusions with constrictive pericarditis, the diagnosis of constrictive pericarditis is not readily entertained in patients with undiagnosed pleural effusions.
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19
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Fang L, Yu W, Yu G, Ye B, Chen G. Predictive value of matrix metalloprotease 9 on surgical outcomes after pericardiectomy. J Cardiothorac Surg 2022; 17:50. [PMID: 35321732 PMCID: PMC8943958 DOI: 10.1186/s13019-022-01796-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effects of matrix metalloproteases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) expressions on the patients with constrictive pericarditis undergoing pericardiectomy remain unclear. This study explored the associations of MMPs and TIMPs expressions with postoperative outcomes in these patients. METHODS Pericardial specimens were obtained during pericardiectomy from the patients with constrictive pericarditis. The levels of MMP1, MMP2, MMP9 and TIMP1 in pericardium were analyzed by quantitative real-time polymerase chain reaction. The enrolled patients were divided into two groups according to the optimal cutoff value of gene expression predicting postoperative complications. Postoperative outcomes were compared between the two groups. Binary logistic regression analysis was performed to determine the degree of contribution of gene expression on postoperative outcomes. RESULTS A total of 22 patients and their pericardial specimens were included. The level of MMP9 was significantly associated with postoperative complications and the optimal cutoff value predicting postoperative complications was 3.67. The patients with low level of MMP9 (< 3.67) had lower incidence of postoperative complications (P = 0.002), shorter postoperative intensive care unit (P = 0.040) and hospital stay (P = 0.043) in comparison to those with high level of MMP9 (≥ 3.67). Binary logistic regression analysis showed that high level of MMP9 increased the risk of postoperative complications (OR 27.096, 95% CI 1.166-629.886, P = 0.040). CONCLUSIONS High level of MMP9 in the pericardium was associated with poor postoperative outcomes and was the independent risk factor of postoperative complications. The level of MMP9 could be used as a potential marker for prediction of surgical outcomes.
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Affiliation(s)
- Likui Fang
- Department of Thoracic Surgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Wenfeng Yu
- Department of Thoracic Surgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Guocan Yu
- Department of Thoracic Surgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Bo Ye
- Department of Thoracic Surgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Gang Chen
- Department of Thoracic Surgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
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20
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Yang Z, Wang H, Lv Q, Du X, Zhu J, Dong J. Case Report: “Gourd-Shaped” Heart Strangled by Localized Annular Calcification of the Left Ventricle: A Rare Case of Constrictive Pericarditis. Front Cardiovasc Med 2022; 9:834262. [PMID: 35187134 PMCID: PMC8854651 DOI: 10.3389/fcvm.2022.834262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022] Open
Abstract
We report a rare case of a 43-year-old woman with calcific annular constrictive pericarditis (CP) encircling the basal segment of the right ventricle and the mid-segment of the left ventricle (LV) lateral wall. Over time, localized calcification has caused LV to be tightly strangled and shaped like a gourd. However, multimodality imaging confirmed no significantly clinical constriction associated with decreased cardiac movement and function. Additionally, cardiac magnetic resonance feature tracking confirmed the relatively preserved diastolic function and the characteristic “plateau” pattern of CP. The treatment strategy of this case is challenging and dialectical.
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Affiliation(s)
- Zhiyun Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qiang Lv
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Junming Zhu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- Department of Cardiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- *Correspondence: Jianzeng Dong
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21
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Prashar A, Shim SJ, Esber Y, Epstein J, Maheepala K, Rees D. Cardiovascular complications of mantle field radiation: a case series. Eur Heart J Case Rep 2022; 6:ytac017. [PMID: 35174307 PMCID: PMC8846184 DOI: 10.1093/ehjcr/ytac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/26/2021] [Accepted: 01/10/2022] [Indexed: 11/30/2022]
Abstract
Background Mantle field radiotherapy has been known to cause cardiovascular complications even years after therapy. Complications include pericardial disease, coronary artery disease, and conduction abnormalities. Case summary We present a case series of two patients who developed cardiovascular complications years after receiving mantle radiation. Patient 1 is a 52-year-old man who presented with symptoms of heart failure. He had a neurostimulator which precluded him from cardiac magnetic resonance imaging. Haemodynamic findings on right heart catheterization raised suspicion for constrictive pericarditis and pericardiectomy was performed. Histopathological analysis reported dense, sclerotic fibrous tissue consistent with radiation-related changes. Patient 2 is a 37-year-old man with a 2-month history of chest pain and exertional dyspnoea who was admitted for management of coronary artery disease. Coronary angiography demonstrated bilateral subclavian artery stenosis and an elevated left ventricular end-diastolic pressure (50 mmHg). He had bilateral percutaneous subclavian artery stenting. Both patients had complete resolution of symptoms on follow-up. Discussion Our case series emphasizes the need for an index of suspicion for radiation-related cardiovascular changes in patients who have a history of mantle radiation, especially in younger patients. This was especially pertinent in the case of our first patient who presented a diagnostic challenge due to certain patient factors. Our second patient is a case of subclavian artery stenosis which is less frequently reported as a complication of mantle radiation in the literature.
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Affiliation(s)
- Abhisheik Prashar
- Department of Cardiology, St George Hospital, Sydney, NSW 2217, Australia
- St George and Sutherland Clinical School, UNSW Medicine, UNSW Sydney, Sydney, Australia
| | - So-Jung Shim
- St George and Sutherland Clinical School, UNSW Medicine, UNSW Sydney, Sydney, Australia
| | - Yamema Esber
- St George and Sutherland Clinical School, UNSW Medicine, UNSW Sydney, Sydney, Australia
| | - Jessica Epstein
- Department of Cardiology, St George Hospital, Sydney, NSW 2217, Australia
| | - Krishan Maheepala
- Department of Cardiology, St George Hospital, Sydney, NSW 2217, Australia
- St George and Sutherland Clinical School, UNSW Medicine, UNSW Sydney, Sydney, Australia
| | - David Rees
- Department of Cardiology, St George Hospital, Sydney, NSW 2217, Australia
- St George and Sutherland Clinical School, UNSW Medicine, UNSW Sydney, Sydney, Australia
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22
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Bizzi E, Picchi C, Mastrangelo G, Imazio M, Brucato A. Recent advances in pericarditis. Eur J Intern Med 2022; 95:24-31. [PMID: 34556390 DOI: 10.1016/j.ejim.2021.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/27/2021] [Accepted: 09/04/2021] [Indexed: 12/15/2022]
Abstract
Pericardial diseases are an heterogeneous group of entities, ranging from acute pericarditis to asymptomatic pericardial effusions. New advances in understanding the processes underlying them have been made. In 2020 a prospective study defined the reference intervals of the component of normal pericardial fluid, that was found to be rich in nucleated cells, proteins, albumin and LDH, at levels compatible with the inflammatory exudates of other biological fluids such as pleural or peritoneal fluid; Light's criteria should not be used to evaluate it. Recently we also analyzed systematically large chronic idiopathic non-inflammatory pericardial effusions, observing that a non-invasive wait-and-see approach may be the best choice in clinical practice in oligosymptomatic cases. Concerning acute recurrent pericarditis (RP), an innovative interaction between cardiologists, internists and pediatric rheumatologists led to the intuition of a pivotal role of IL-1 in recurrent pericarditis characterized by an evident inflammatory recurrent phenotype, and recent data have shown the striking efficacy of anakinra and rilonacept in these patients. The proper selection of the patient is important; the ideal candidate for anti-IL-1 therapy is the patient with RP with high levels of serum C-reactive protein, high fever, neutrophil leukocitosis, pleuropulmonary involvement, frequent exacerbations and resistant to conventional therapy. On the contrary, anti-IL-1 drugs are not indicated in patients with pericardial effusion whose cause is not attributable to inflammatory phenomena. Finally, many patients with RP are women of childbearing age, and the possibility for these women to become pregnant must be addressed by multidisciplinary teams.
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Affiliation(s)
- Emanuele Bizzi
- Internal Medicine Department, Fatebenefratelli Hospital, Piazzale Principessa Clotilde 3, 20121, Milano, Italy.
| | - Chiara Picchi
- Internal Medicine Department, Fatebenefratelli Hospital, Piazzale Principessa Clotilde 3, 20121, Milano, Italy.
| | - Greta Mastrangelo
- Department of Pediatrics, Fatebenefratelli Hospital, Piazzale Principessa Clotilde 3, 20121, Milano, Italy.
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia, 15, 33100, Udine, Italy
| | - Antonio Brucato
- University of Milano, Department of biomedical and clinical sciences "Luigi Sacco", Fatebenefratelli Hospital, Piazzale Principessa Clotilde 3, 20121, Milano, Italy.
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23
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Ferrel MN, Iriana S, Raymond Thomason I, Ma CL, Tsarova K, Wilson BD, McKellar SH, Ryan JJ. Constrictive pericarditis in the setting of repeated chest trauma in a mixed martial arts fighter. BMC Cardiovasc Disord 2021; 21:561. [PMID: 34809565 PMCID: PMC8607559 DOI: 10.1186/s12872-021-02378-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 11/10/2021] [Indexed: 11/21/2022] Open
Abstract
Background Constrictive pericarditis (CP) is characterized by scarring and loss of elasticity of the pericardium. This case demonstrates that mixed martial arts (MMA) is a previously unrecognized risk factor for CP, diagnosis of which is supported by cardiac imaging, right and left heart catheterization, and histological findings of dense fibrous tissue without chronic inflammation.
Case presentation A 47-year-old Caucasian male former mixed martial arts (MMA) fighter from the Western United States presented to liver clinic for elevated liver injury tests (LIT) and a 35-pound weight loss with associated diarrhea, lower extremity edema, dyspnea on exertion, and worsening fatigue over a period of 6 months. Past medical history includes concussion, right bundle branch block, migraine headache, hypertension, chronic pain related to musculoskeletal injuries and fractures secondary to MMA competition. Involvement in MMA was extensive with an 8-year history of professional MMA competition and 13-year history of MMA fighting with recurrent trauma to the chest wall. The patient also reported a 20-year history of performance enhancing drugs including testosterone. Physical exam was notable for elevated jugular venous pressure, hepatomegaly, and trace peripheral edema. An extensive workup was performed including laboratory studies, abdominal computerized tomography, liver biopsy, echocardiogram, and cardiac magnetic resonance imaging. Finally, right and left heart catheterization—the gold standard—confirmed discordance of the right ventricle-left ventricle, consistent with constrictive physiology. Pericardiectomy was performed with histologic evidence of chronic pericarditis. The patient’s hospital course was uncomplicated and he returned to NYHA functional class I.
Conclusions CP can be a sequela of recurrent pericarditis or hemorrhagic effusions and may have a delayed presentation. In cases of recurrent trauma, CP may be managed with pericardiectomy with apparent good outcome. Further studies are warranted to analyze the occurrence of CP in MMA so as to better define the risk in such adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02378-8.
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Affiliation(s)
- Meganne N Ferrel
- University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Sentia Iriana
- Division of Gastroenterology, Department of Medicine, University of Utah, Salt Lake City, UT, 84132, USA
| | - I Raymond Thomason
- Division of Gastroenterology, Department of Medicine, University of Utah, Salt Lake City, UT, 84132, USA
| | - Christy L Ma
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah Health, 30 North 1900 East, Room 4A100, Salt Lake City, UT, 84132, USA
| | - Katsiaryna Tsarova
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah Health, 30 North 1900 East, Room 4A100, Salt Lake City, UT, 84132, USA
| | - Brent D Wilson
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah Health, 30 North 1900 East, Room 4A100, Salt Lake City, UT, 84132, USA
| | - Stephen H McKellar
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, 84132, USA
| | - John J Ryan
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah Health, 30 North 1900 East, Room 4A100, Salt Lake City, UT, 84132, USA.
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24
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Yousif N, Alnuwakhtha A, Darwish A, Arekat Z, Abdulrahman S. A case report of tuberculous constrictive pericarditis necessitating total pericardiectomy. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab328. [PMID: 34738067 PMCID: PMC8561250 DOI: 10.1093/ehjcr/ytab328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/17/2021] [Accepted: 07/13/2021] [Indexed: 11/13/2022]
Abstract
Background Constrictive pericarditis (CP) is one of the most serious sequelae of tuberculous pericarditis, which is characterized by heart constriction secondary to intense pericardial inflammation and thickening. Several invasive and non-invasive diagnostic modalities are crucial to address the challenges of confirming the diagnosis of CP and to expedite timely intervention. Case summary This study reports the case of a Bahraini male with tuberculous lymphadenitis diagnosed with CP as a result of various evaluations. The patient underwent urgent total pericardiectomy and showed remarkable recovery with complete resolution of heart failure symptoms. Discussion This case demonstrates the paramount importance of early diagnosis and treatment for patients with CP. In this unique case, the acoustic windows on echocardiography were suboptimal because of pericardial thickening. Further, computed tomography did not show significant calcification of the thickened pericardium. A novel approach of assessing haemodynamics through the right antecubital vein and right radial artery facilitated the accurate diagnosis of CP with confidence. Thereafter, successful pericardiectomy revealed a markedly thickened and stiff pericardium with many abscesses and dense adhesions encasing the heart, and pericardial biopsy showed large caseating granulomas. This case exemplifies the difficulty in diagnosing CP and the favourable outcomes achieved with well-timed surgical intervention.
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Affiliation(s)
- Nooraldaem Yousif
- Mohammed Bin Khalifa Bin Sulman Al Khalifa Specialist Cardiac Centre (MKCC), Awali, Kingdom of Bahrain
| | - Abdulla Alnuwakhtha
- Mohammed Bin Khalifa Bin Sulman Al Khalifa Specialist Cardiac Centre (MKCC), Awali, Kingdom of Bahrain
| | - Abdulla Darwish
- Department of Pathology, Royal Medical Services, Bahrain Defense Force Hospital, Riffa, Kingdom of Bahrain
| | - Zaid Arekat
- Mohammed Bin Khalifa Bin Sulman Al Khalifa Specialist Cardiac Centre (MKCC), Awali, Kingdom of Bahrain
| | - Seham Abdulrahman
- Mohammed Bin Khalifa Bin Sulman Al Khalifa Specialist Cardiac Centre (MKCC), Awali, Kingdom of Bahrain
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25
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Jain CC, Miranda WR, El Sabbagh A, Nishimura RA. A Simplified Method for the Diagnosis of Constrictive Pericarditis in the Cardiac Catheterization Laboratory. JAMA Cardiol 2021; 7:100-104. [PMID: 34550314 DOI: 10.1001/jamacardio.2021.3478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Enhanced ventricular interdependence is a highly sensitive and specific criterion for the diagnosis of constrictive pericarditis (CP), but simultaneous ventricular measurements can be challenging at cardiac catheterization. Ejection times (ETs) correlate with stroke volumes and can be easily measured from arterial pressure tracings. Objective To assess respirophasic changes in pulmonary artery (PA) ETs and aorta (Ao) ETs as a marker for enhanced ventricular interdependence. Design, Setting, and Participants Retrospective analysis of simultaneous left-side and right-side heart catheterizations between January 2006 and January 2017 was performed. The data were analyzed in June 2020. All catheterizations were performed at the Mayo Clinic, Rochester, Minnesota. This study evaluated patients undergoing left-side and right-side heart catheterization for assessment of CP after noninvasive evaluation was inconclusive. Main Outcomes and Measures Measurements of the PA and Ao ETs were made during inspiration and expiration. Ventricular interaction was mainly assessed by evaluating the difference of ETs from expiration to inspiration as well as the difference in Ao minus the difference in PA. Results A total of 10 patients with surgically proven CP and 10 patients without CP (restrictive cardiomyopathy or severe tricuspid regurgitation) were identified. Of these 20 included patients, 10 (50%) were female, and the median (interquartile range) age was 59.5 (47.0-67.5) years. There were no significant differences in demographic characteristics or baseline hemodynamic measurements. In patients with CP compared with those without CP, there was a significantly greater decrease in PA ET (mean [SD], -31.8 [28.6] vs 5.1 [9.5]; P < .001) and a nonsignificantly greater increase in Ao ET (mean [SD], 19.0 [15.7] vs 10.5 [9.1]; P = 0.20) during expiration vs inspiration. Thus, the difference in Ao ET minus the difference in PA ET during expiration vs inspiration was significantly greater in those with CP compared with those without CP (mean [SD], 50.8 [22.5] milliseconds vs 5.4 [15.2] milliseconds; P < .001). Conclusions and Relevance In this study, PA and Ao measurements of ETs throughout the respiratory cycle were a simple, easily obtainable, and accurate parameter for the diagnosis of CP.
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Affiliation(s)
- C Charles Jain
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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26
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Pahwa S, Crestanello J, Miranda W, Bernabei A, Polycarpou A, Schaff H, Dearani J, Stulak J, Pochettino A, Daly R, Lahr B, Viehman J, Greason K. Outcomes of pericardiectomy for constrictive pericarditis following mediastinal irradiation. J Card Surg 2021; 36:4636-4642. [PMID: 34547827 DOI: 10.1111/jocs.15996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pericardiectomy for postradiation constrictive pericarditis has been reported to generally have unfavorable outcomes. This study sought to evaluate surgical outcomes in a large cohort of patients undergoing pericardiectomy for radiation-associated pericardial constriction. METHODS A retrospective analysis of all patients (≥18 years) who underwent pericardiectomy for a diagnosis of constrictive pericarditis with a prior history of mediastinal irradiation from June 2002 to June 2019 was conducted. There were 100 patients (mean age 57.2 ± 10.1 years, 49% females) who met the inclusion criteria. Records were reviewed to look at the surgical approach, the extent of resection, early mortality, and late survival. RESULTS The overall operative mortality was 10.1% (n = 10). The rate of operative mortality decreased over the study period; however, the test of the trend was not statistically significant (p = .062). Hodgkin's disease was the most common malignancy (64%) for which mediastinal radiation had been received. Only 27% of patients had an isolated pericardiectomy, and concomitant pericardiectomy and valve surgery were performed in 46% of patients. Radical resection was performed in 50% of patients, whereas 47% of patients underwent subtotal resection. Prolonged ventilation (26%), atrial fibrillation (21%), and pleural effusion (16%) were the most common postoperative complications. The overall 1, 5-, and 10-years survival was 73.6%, 53.4%, and 32.1%, respectively. Increasing age (hazard ratio, 1.044, 95% confidence interval 1.017-1.073) appeared to have a significant negative effect on overall survival in the univariate model. CONCLUSION Pericardiectomy performed for radiation-associated constrictive pericarditis has poor long-term outcomes. The early mortality, though high (~10%), has been showing a decreasing trend in the test of time.
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Affiliation(s)
- Siddharth Pahwa
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - William Miranda
- Department of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Annalisa Bernabei
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Andreas Polycarpou
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Hartzell Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alberto Pochettino
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian Lahr
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason Viehman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
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27
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CUPS to Manage Pericarditis. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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28
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Saeed S, Haaverstad R, Blomberg B, Bleie Ø, Lunde T. Long-term echocardiographic follow-up of a patient with constrictive pericarditis treated with antituberculosis drugs and pericardiectomy. BMJ Case Rep 2021; 14:14/8/e244665. [PMID: 34446521 PMCID: PMC8395355 DOI: 10.1136/bcr-2021-244665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A middle-aged man presented to the Department of Medicine of our hospital due to exertional dyspnoea, ascites and peripheral oedema. He was later transferred to the Department of Heart Disease as his echocardiography indicated constrictive pericarditis, confirmed by cardiac MRI and cardiac catheterisation. After a thorough investigation, his constrictive pericarditis was assumed to be caused by tuberculosis. He was treated with antituberculosis therapy followed by successful surgical subtotal pericardiectomy, leading to immediate improvement of haemodynamics, regression of symptoms and recovery of cardiac function. The patient remained stable at 5-year echocardiographic follow-up with no evidence of diastolic dysfunction.
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Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rune Haaverstad
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Bjørn Blomberg
- National Advisory Unit on Tropical Infectious Diseases, Haukeland Universitetssjukehus, Bergen, Norway .,Department of Clinical Science, Universitetet i Bergen, Bergen, Norway
| | - Øyvind Bleie
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Torbjørn Lunde
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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29
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Fang L, Zheng H, Yu W, Chen G, Zhong F. Effects of Intraoperative Fluid Management on Postoperative Outcomes After Pericardiectomy. Front Surg 2021; 8:673466. [PMID: 34422891 PMCID: PMC8372555 DOI: 10.3389/fsurg.2021.673466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/08/2021] [Indexed: 11/21/2022] Open
Abstract
Background: The effects of intraoperative fluid management on the patients with constrictive pericarditis undergoing pericardiectomy remain unclear. This study explored the relationship between intraoperative fluid management and postoperative outcomes in these patients. Methods: We retrospectively studied 92 patients with constrictive pericarditis undergoing pericardiectomy and assigned them to the restrictive group and the liberal group according to the intraoperative total fluid infusion rate. Postoperative outcomes were compared between the two groups. Binary logistic regression analysis was performed to determine the relationship between the intraoperative total fluid infusion rate and postoperative outcomes. Results: There were 46 (50.0%) cases in the restrictive group and 46 (50.0%) cases in the liberal group. Compared with the liberal group, the restrictive group had significantly lower incidences of postoperative complications and cardiac complications (P = 0.005 and P = 0.006, respectively). Binary logistics regression analysis also showed the increased risks of postoperative complications (OR, 3.551; 95% CI, 1.192–10.580; P = 0.023) and cardiac complications (OR, 6.037; 95% CI, 1.472–25.052; P = 0.013) at the liberal group. In addition, the restrictive group had shorter postoperative hospital stay (P = 0.026) in comparison to the liberal group. Conclusion: In patients with constrictive pericarditis undergoing pericardiectomy the intraoperative total fluid infusion rate was significantly associated with postoperative outcomes. Restrictive fluid management strategy was related to the positive effects on enhanced recovery after surgery and could be advised as the preferred intraoperative fluid management policy.
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Affiliation(s)
- Likui Fang
- Department of Thoracic Surgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Zheng
- Department of Nursing, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenfeng Yu
- Department of Thoracic Surgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Gang Chen
- Department of Thoracic Surgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fangming Zhong
- Department of Thoracic Surgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
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30
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Yang JH, Miranda WR, Nishimura RA, Greason KL, Schaff HV, Oh JK. Prognostic importance of mitral e' velocity in constrictive pericarditis. Eur Heart J Cardiovasc Imaging 2021; 22:357-364. [PMID: 32514577 DOI: 10.1093/ehjci/jeaa133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS Increased medial mitral annulus early diastolic velocity (e') plays an important role in the echocardiographic diagnosis of constrictive pericarditis (CP) and mitral e' velocity is also a marker of underlying myocardial disease. We assessed the prognostic implication of mitral e' for long-term mortality after pericardiectomy in patients with CP. METHODS AND RESULTS We studied 104 surgically confirmed CP patients who underwent echocardiography and cardiac catheterization within 7 days between 2005 and 2013. Patients were classified as primary CP (n = 45) or mixed CP (n = 59) based on the clinical history of concomitant myocardial disease. On multivariable analysis, medial e' velocity and mean pulmonary artery pressure were independently associated with long-term mortality post-pericardiectomy. There were significant differences in survival rates among the groups divided by cut-off values of 9.0 cm/s and 29 mmHg for medial e' and mean pulmonary artery pressure, respectively (both P < 0.001). Ninety-two patients (88.5%) had elevated pulmonary artery wedge pressure (PAWP) (≥15 mmHg); there was no significant correlation between medial E/e' and PAWP (r = 0.002, P = 0.998). However, despite the similar PAWP between primary CP and mixed CP groups (21.6 ± 5.4 vs. 21.2 ± 5.8, P = 0.774), all primary CP individuals with elevated PAWP had medial E/e' <15 as opposed to 34 patients (57.6%) in the mixed CP group (P < 0.001). CONCLUSION Increased mitral e' velocity is associated with better outcomes in patients with CP. A paradoxical distribution of the relationship between E/e' and PAWP is present in these patients but there is no direct inverse correlation between them.
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Affiliation(s)
- Jeong Hoon Yang
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.,Division of Cardiology, Department of Critical Care Medicine and Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.,Division of Cardiology, Department of Critical Care Medicine and Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
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31
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Lim K, Yang JH, Miranda WR, Chang SA, Jeong DS, Nishimura RA, Schaff H, Soo WM, Greason KL, Oh JK. Clinical significance of pulmonary hypertension in patients with constrictive pericarditis. Heart 2021; 107:1651-1656. [PMID: 34285103 DOI: 10.1136/heartjnl-2021-319149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/08/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We investigated haemodynamics and clinical outcomes according to type of pulmonary hypertension (PH) in patients with constrictive pericarditis (CP). BACKGROUND As the prevalence of CP with concomitant myocardial disease (mixed CP) grows, PH is more commonly seen in patients with CP. However, haemodynamic and outcome data according to the presence or absence of PH are limited. METHODS 150 patients with surgically confirmed CP who underwent echocardiography and cardiac catheterisation within 7 days at two tertiary centres were divided into three groups: no-PH, isolated postcapillary PH (Ipc-PH) and combined postcapillary and precapillary PH (Cpc-PH). Primary outcome was all-cause mortality during follow-up. RESULT In this retrospective cohort study, 110 (73.3%) had PH (mean pulmonary artery pressure ≥25 mm Hg). Cpc-PH, using defined cut-offs for pulmonary vascular resistance (>3 Wood units) or diastolic pulmonary gradient (≥7 mm Hg), was seen in 18 patients (12%). The Cpc-PH group had a higher prevalence of comorbidities (diabetes and atrial fibrillation) and concomitant myocardial disease as an aetiology of CP than other groups. Pulmonary vascular resistance had a significant direct correlation with medial E/e' by Doppler echocardiography (r=0.404, p<0.001). Survival rate was significantly lower in the Cpc-PH than the no-PH (p=0.002) and Ipc-PH (p=0.024) groups. On multivariable analysis, age, New York Heart Association functional class IV, medial e' velocity, Cpc-PH and Ipc-PH were independently associated with long-term mortality. CONCLUSION Combined postcapillary and precapillary PH develops in a subset of patients with CP and is associated with long-term mortality after pericardiectomy.
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Affiliation(s)
- Kyunghee Lim
- Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea (the Republic of)
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of).,Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the republoic of)
| | - William R Miranda
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, Korea (the Republic of)
| | - Rick A Nishimura
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Hartzell Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Wern Miin Soo
- Department of Cardiology, National University Hospital, Singapore
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jae K Oh
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of).,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Giordani AS, De Gaspari M, Baritussio A, Rizzo S, Carturan E, Basso C, Napodano M, Testolin L, Marcolongo R, Caforio ALP. A rare cause of effusive-constrictive pericarditis. ESC Heart Fail 2021; 8:4313-4317. [PMID: 34173727 PMCID: PMC8497351 DOI: 10.1002/ehf2.13470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 12/28/2022] Open
Abstract
Effusive–constrictive pericarditis (ECP) is an uncommon diagnosis, frequently missed due to its heterogeneous presentation, but a potentially reversible cause of heart failure. A 62‐year‐old Caucasian male presented with remittent right heart failure and mild–moderate pericardial effusion. Following an initial diagnosis of idiopathic pericarditis, indomethacin was started, but the patient shortly relapsed, presenting with severe pericardial effusion and signs of cardiac tamponade, requiring pericardiocentesis. ECP was diagnosed on cardiac catheterization. Cardiac computed tomography showed non‐calcified, mildly thickened and inflamed parietal pericardium. Pericardiectomy was performed with symptoms remission. On histological examination of pericardium, chronic non‐necrotizing granulomatous inflammation was noted. Polymerase chain reaction assay was positive for non‐tuberculous mycobacteria. This case represents a rare finding of ECP with unusual presentation due to atypical mycobacteriosis in a non‐immunocompromised patient and in a non‐endemic area. Pericardiectomy can be an effective option in cases unresponsive to anti‐inflammatory treatment, even in the absence of significant pericardial thickening or calcification.
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Affiliation(s)
- Andrea S Giordani
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, Padova, 35128, Italy
| | - Monica De Gaspari
- Cardiac Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Anna Baritussio
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, Padova, 35128, Italy
| | - Stefania Rizzo
- Cardiac Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Elisa Carturan
- Cardiac Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Cristina Basso
- Cardiac Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Massimo Napodano
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, Padova, 35128, Italy
| | - Luca Testolin
- Cardiac Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Renzo Marcolongo
- Haematology and Clinical Immunology, Department of Medicine, University of Padova, Padova, Italy
| | - Alida L P Caforio
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, Padova, 35128, Italy
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Faiza Z, Prakash A, Namburi N, Johnson B, Timsina L, Lee LS. Fifteen-year experience with pericardiectomy at a tertiary referral center. J Cardiothorac Surg 2021; 16:180. [PMID: 34158104 PMCID: PMC8220762 DOI: 10.1186/s13019-021-01561-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/08/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Pericardiectomy has traditionally carried relatively high perioperative mortality and morbidity, with few published reports of intermediate- and long- term outcomes. We investigated our 15-year experience performing pericardiectomy at our institution. Methods Retrospective study of all patients who underwent pericardiectomy at our institution between 2005 and 2019. Baseline demographics, intraoperative details, and postoperative outcomes including long-term survival were analyzed. Results Sixty-three patients were included in the study. 66.7% of subjects underwent isolated pericardiectomy while 33.3% underwent pericardiectomy concomitantly with another cardiac surgical procedure. The most common indications for pericardiectomy were constrictive (79.4%) and hemorrhagic (9.5%) pericarditis. Preoperatively, 76.2% of patients were New York Heart Association class II and III, while postoperatively, 71.4% were class I and II. One-, three-, five-, and ten- year overall mortality was 9.5, 14.3, 20.6, and 25.4%, respectively. Overall pericarditis recurrence rate was 4.8%. Conclusion Pericardiectomy carries relatively high overall mortality rates, which likely reflects underlying disease etiology and comorbidities. Patients with prior cardiac intervention, history of dialysis, and immunocompromised state are associated with worse outcomes.
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Affiliation(s)
- Zainab Faiza
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1801 N. Senate Blvd., Suite 3300, Indianapolis, IN, 46202, USA
| | - Anjali Prakash
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1801 N. Senate Blvd., Suite 3300, Indianapolis, IN, 46202, USA
| | - Niharika Namburi
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1801 N. Senate Blvd., Suite 3300, Indianapolis, IN, 46202, USA
| | - Bailey Johnson
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1801 N. Senate Blvd., Suite 3300, Indianapolis, IN, 46202, USA
| | - Lava Timsina
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1801 N. Senate Blvd., Suite 3300, Indianapolis, IN, 46202, USA
| | - Lawrence S Lee
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1801 N. Senate Blvd., Suite 3300, Indianapolis, IN, 46202, USA.
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Tzani A, Doulamis IP, Tzoumas A, Avgerinos DV, Koudoumas D, Siasos G, Vavuranakis M, Klein A, Kampaktsis PN. Meta-Analysis of Population Characteristics and Outcomes of Patients Undergoing Pericardiectomy for Constrictive Pericarditis. Am J Cardiol 2021; 146:120-127. [PMID: 33539860 DOI: 10.1016/j.amjcard.2021.01.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 01/05/2023]
Abstract
We sought to systematically describe the epidemiology, etiology, clinical and operative characteristics as well as outcomes of patients who underwent pericardiectomy for constrictive pericarditis in the contemporary era. We conducted a systematic search of the MEDLINE, Embase, and Cochrane databases from their inception to April 1, 2020 for studies assessing the outcomes of pericardiectomy in patients with constrictive pericarditis. Studies with patients enrolled before 1985, pediatric patients or studies including >10% tuberculous pericarditis were excluded. The impact of pericarditis etiology on outcomes was evaluated with a meta-analysis. We analyzed 27 eligible studies and 2,114 patients. Etiology was most commonly idiopathic (50.2%), followed by after-cardiac surgery (26.2%) and radiation (6.9%). Patients were mostly men (76%), mean age 58 and with advanced symptoms (NYHA III/IV 70.1%). Total pericardiectomy was preferred (85.8%) and concomitant cardiac surgery was relatively common (23.8%). Operative mortality was 6.9% and 5-year mortality was 32.7%. Radiation and after-cardiac surgery patients had 3 and 2 times higher long-term risk for mortality respectively compared with idiopathic. A sensitivity analysis did not result in changes in the results. Thirty percent of included studies had more than low bias primarily originating from follow up and selection. Pericardiectomy is therefore performed mostly in middle-aged men with advanced symptoms and low co-morbidity burden and still caries significant operative mortality. Radiation and after-cardiac surgery patients have a significantly higher mortality risk compared with idiopathic. Several methodological issues and significant heterogeneity limit the generalization of these data and randomized controlled trials may have to be considered.
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Affiliation(s)
- Aspasia Tzani
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Ilias P Doulamis
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andreas Tzoumas
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Dimitrios Koudoumas
- Department of Surgery, Division of Cardiothoracic Surgery, University of Utah, Salt lake city, Utah
| | - Gerasimos Siasos
- 1st Cardiology Clinic, National and Kapodistrian University of Athens Medical School, Greece
| | - Manolis Vavuranakis
- 1st Cardiology Clinic, National and Kapodistrian University of Athens Medical School, Greece
| | - Allan Klein
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
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35
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Malakan Rad E, Yaghmaei B, Ziaee V, Beirami F, Pouraliakbar H. Multimodality imaging of constrictive pericarditis in H syndrome. Echocardiography 2021; 38:1021-1032. [PMID: 33899966 DOI: 10.1111/echo.15027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/12/2021] [Accepted: 02/26/2021] [Indexed: 11/28/2022] Open
Abstract
This is the first report of constrictive pericarditis (CP) in a 16-year-old boy with H syndrome with pericardial involvement predominantly over the right ventricle with favorable response to anti-inflammatory treatment. H syndrome, first reported in 2008, is a new auto-inflammatory syndrome with multiorgan involvement due to mutation in the SLC29A3 gene. We described the echocardiographic characteristics of asymmetric pericardial involvement and presented the cardiac computed tomography angiographic and magnetic resonance imaging findings. We reviewed the echocardiographic signs of CP, introduced tricuspid E/A respiratory alternans as a novel echocardiographic sign of right ventricular dominant CP, and explained the underlying mechanism.
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Affiliation(s)
- Elaheh Malakan Rad
- Department of Pediatric Cardiology, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Yaghmaei
- Department of Pediatric Intensive Care, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Ziaee
- Department of Pediatrics, Tehran University of Medical Science, Tehran, Iran.,Children's Medical Center, Pediatric Center of Excellence, Tehran, Iran.,Pediatric Rheumatology Research Group, Rheumatology Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Farzaneh Beirami
- Department of Pediatric Intensive Care, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
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Qiao W, Xiao YJ, Wang X, Sun LJ, Chen YX, Ren WD. A novel model of constrictive pericarditis associated with myocardial fibrosis in rats. Clin Exp Pharmacol Physiol 2021; 48:563-574. [PMID: 33349990 DOI: 10.1111/1440-1681.13449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 11/29/2020] [Indexed: 12/15/2022]
Abstract
An efficient animal model is fundamental for studies on the underlying mechanisms of constrictive pericarditis (CP). A novel CP rat model was established by pericardial injection composing of lipopolysaccharides (LPS) and talcum powder without thoracotomy. Pathological changes were confirmed by histological staining. E-flow Doppler of mitral valve, tissue Doppler E' in the medial mitral annular (E'sep ) and the lateral mitral annular (E'lat ) were measured to assess ventricular filling function. Circumferential, longitudinal, and radial strains (SC, SL and SR) and the respective strain rates (SrC, SrL and SrR) were analyzed in interventricular septum (IVS) and left ventricular free wall (LVFW). Rat cardiac fibroblasts (CFs) were treated with LPS. The activation of transforming growth factor β1 (TGF-β1) was confirmed by Q-PCR and western blot assays. Thickening of pericardium and fibrosis in pericardium and subepicardial myocardium were showed in the model group. Diastolic dysfunction in the CP group was indicated by decreased E'lat and E'lat /E'sep , increased E/E'lat , decreased EFW of SrC and SrL, increased AIVS and decreased E/A of SrC, SrL and SrR. Systolic dysfunction was indicated by decreased SCFW and SLFW in CP rats. The levels of TGF-β1, p-Smad2/3, α-smooth muscle actin (α-SMA), and collagen-I/III (COL-I/III) were increased in the CP group. The increased TGF-β1 that induced by LPS activated and phosphorylated Smad2/3 resulting in the secretion of α-SMA and COL-I/III. This model is of vital importance in studying the pathogenesis of CP.
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Affiliation(s)
- Wei Qiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang-Jie Xiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xin Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Li-Juan Sun
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Ultrasound, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Yi-Xin Chen
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wei-Dong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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Liu VC, Fritz AV, Burtoft MA, Martin AK, Greason KL, Ramakrishna H. Pericardiectomy for Constrictive Pericarditis: Analysis of Outcomes. J Cardiothorac Vasc Anesth 2021; 35:3797-3805. [PMID: 33722460 DOI: 10.1053/j.jvca.2021.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 01/17/2023]
Abstract
Constrictive pericarditis is caused by pericardial inflammation and fibrosis, leading to diastolic heart failure. The diagnosis requires a high index of suspicion because it often can mimic restrictive myocardial disease and cardiac tamponade and can be associated with severe tricuspid regurgitation and chronic liver disease. Patients who remain undiagnosed can experience a 90% mortality rate, and for those who undergo pericardiectomy, the survival rate varies significantly, depending on the underlying etiology and preoperative functional class of the patient. In this article, the authors review the pathophysiology, echocardiographic findings, management, and surgical outcomes of constrictive pericarditis to aid the cardiothoracic anesthesiologist in the perioperative management of this disorder.
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Affiliation(s)
- Victor C Liu
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Ashley V Fritz
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Melissa A Burtoft
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Archer K Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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Eck BL, Flamm SD, Kwon DH, Tang WHW, Vasquez CP, Seiberlich N. Cardiac magnetic resonance fingerprinting: Trends in technical development and potential clinical applications. PROGRESS IN NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY 2021; 122:11-22. [PMID: 33632415 PMCID: PMC8366914 DOI: 10.1016/j.pnmrs.2020.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 05/02/2023]
Abstract
Quantitative cardiac magnetic resonance has emerged in recent years as an approach for evaluating a range of cardiovascular conditions, with T1 and T2 mapping at the forefront of these developments. Cardiac Magnetic Resonance Fingerprinting (cMRF) provides a rapid and robust framework for simultaneous quantification of myocardial T1 and T2 in addition to other tissue properties. Since the advent of cMRF, a number of technical developments and clinical validation studies have been reported. This review provides an overview of cMRF, recent technical developments, healthy subject and patient studies, anticipated technical improvements, and potential clinical applications. Recent technical developments include slice profile and pulse efficiency corrections, improvements in image reconstruction, simultaneous multislice imaging, 3D whole-ventricle imaging, motion-resolved imaging, fat-water separation, and machine learning for rapid dictionary generation. Future technical developments in cMRF, such as B0 and B1 field mapping, acceleration of acquisition and reconstruction, imaging of patients with implanted devices, and quantification of additional tissue properties are also described. Potential clinical applications include characterization of infiltrative, inflammatory, and ischemic cardiomyopathies, tissue characterization in the left atrium and right ventricle, post-cardiac transplantation assessment, reduction of contrast material, pre-procedural planning for electrophysiology interventions, and imaging of patients with implanted devices.
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Affiliation(s)
- Brendan L Eck
- Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Scott D Flamm
- Heart and Vascular Institute and Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Deborah H Kwon
- Heart and Vascular Institute and Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - W H Wilson Tang
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Claudia Prieto Vasquez
- School of Biomedical Engineering and Imaging Sciences, King's College London, Westminster Bridge Road, London, UK.
| | - Nicole Seiberlich
- Department of Radiology, University of Michigan, 1150 West Medical Center Drive, Ann Arbor, MI 48109, USA.
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Clinical features and prognosis of surgically proven constrictive pericarditis after orthotopic heart transplantation. J Heart Lung Transplant 2021; 40:241-246. [PMID: 33546972 DOI: 10.1016/j.healun.2020.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 11/22/2022] Open
Abstract
Constrictive pericarditis (CP) results in pericardial non-compliance and diastolic dysfunction. Definitive treatment is pericardiectomy, but data on CP after orthotopic heart transplantation (OHT) are limited. Accordingly, a retrospective review of 8 cases of surgically proven CP after OHT undergoing pericardiectomy was conducted. In this series, all patients were male. The median time to symptomatic CP after OHT was 1.7 years (range: 0.8-18.1 years). The echocardiographic assessment was diagnostic for CP in 3 cases (38%). Cross-sectional imaging was performed in 6 cases, revealing ≥ mild pericardial thickening in all. A total of 6 patients (75%) underwent cardiac catheterization, which revealed CP in 5 (83%). Post-pericardiectomy 30-day mortality was 13% (1 patient). The median survival after pericardiectomy was 2.3 years (range: 18 days-14.6 years) and 5-year survival was 29%. Overall, CP after OHT represents a subset of patients with CP with high morbidity and mortality, and multimodality assessment is essential for its diagnosis. Despite a relatively low surgical mortality, long-term survival is poor.
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40
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Bhattad PB, Jain V. Constrictive Pericarditis: A Commonly Missed Cause of Treatable Diastolic Heart Failure. Cureus 2020; 12:e8024. [PMID: 32528763 PMCID: PMC7282374 DOI: 10.7759/cureus.8024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Constrictive pericarditis arises as a result of the fibrous thickening of the pericardium due to chronic inflammatory changes from various injuries. Increased pulmonary and systemic venous pressures manifest clinical features of left and right heart failure. Idiopathic or post-viral pericarditis is the most common cause followed by postpericardiotomy, radiation-induced causes. Right-sided heart failure symptoms predominate over left-sided heart failure symptoms due to the equalization of pressures. No single diagnostic test can provide a definitive diagnosis or evidence of constrictive pericarditis. Medical management is difficult for constrictive pericarditis. The treatment of choice for constrictive pericarditis is pericardiectomy.
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Affiliation(s)
| | - Vinay Jain
- Radiology, James H. Quillen Veterans Affairs Medical Center, Johnson City, USA
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41
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Abstract
Abstract
Purpose of Review
To review the latest developments and the current role of the cardiac magnetic resonance (CMR) in pericardial diseases and their complications.
Recent Findings
Cardiac Magnetic Resonance (CMR) has the ability to incorporate anatomy, physiology, and “virtual histology” strategies to achieve the most accurate diagnosis for even the most demanding, pericardial diseases.
Summary
Acute, chronic, recurrent, and constrictive pericarditis as well as pericarditis related complications, pericardial masses and congenital pericardial defects are commonly encountered in clinical practice with relatively significant morbidity and mortality. Owing to the challenging diagnosis, CMR imaging is often employed in confirming the diagnosis and elucidating the underling pathophysiology. In this review we outline the common CMR techniques and their expected diagnostic outcomes.
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Abstract
PURPOSE OF REVIEW To review the echo-Doppler findings in effusive-constrictive pericarditis (ECP). ECP corresponds to the coexistence of a hemodynamically significant pericardial effusion and markedly reduced compliance of the pericardium, manifested by constrictive physiology post-pericardiocentesis. RECENT FINDINGS We summarize herein the recent observations regarding the prevalence of ECP based on echocardiography as well as the pre- and post-pericardiocentesis echo-Doppler features of ECP. ECP diagnosed by echocardiography was seen in approximately 15% of patients with ECP pre- and post-pericardiocentesis echo-Doppler findings sharing features with both cardiac tamponade and constrictive pericarditis. ECP post-pericardiocentesis is common but its natural history in the current era might be better than previously reported. Further studies and (particularly simultaneous echocardiography-cardiac catheterization) are still critically needed to better understand the underlying hemodynamics of ECP. Moreover, it remains to be determined whether pre- and post-pericardiocentesis echo-Doppler findings can be used to prognosticate or to guide therapy of those undergoing pericardiocentesis.
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D’Elia E, Ferrazzi P, Imazio M, Simon C, Pentiricci S, Stamerra CA, Iacovoni A, Gori M, Duino V, Senni M, Brucato AL. Constrictive pericarditis. J Cardiovasc Med (Hagerstown) 2019; 20:725-726. [DOI: 10.2459/jcm.0000000000000844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Yang JH, Miranda WR, Borlaug BA, Nishimura RA, Schaff HV, Greason KL, Maleszewski JJ, Oh JK. Right Atrial/Pulmonary Arterial Wedge Pressure Ratio in Primary and Mixed Constrictive Pericarditis. J Am Coll Cardiol 2019; 73:3312-3321. [DOI: 10.1016/j.jacc.2019.03.522] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 12/14/2022]
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Severe Calcific Chronic Constrictive Pericarditis as an Unexpected Cause of Death. ACTA ACUST UNITED AC 2019; 40:273-274. [DOI: 10.1097/paf.0000000000000478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Rivero A, Aceña A, Orejas M, Hernandez-Estefania R. Recurrent haemorrhagic pericardial effusion due to idiopathic pericarditis: a case report. Eur Heart J Case Rep 2019; 3:ytz018. [PMID: 31020260 PMCID: PMC6439374 DOI: 10.1093/ehjcr/ytz018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/07/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Haemorrhagic pericardial effusion (PE) has been described in pericarditis due to infection, neoplasm, collagen vascular disease, uraemia, pericardial inflammation after acute myocardial infarction, trauma, irradiation, and idiopathic pericarditis. Patients with large haemorrhagic PE develop recurrence or constrictive pericarditis (CP) frequently as complication without being treated intensively. CASE SUMMARY A 22-year-old female patient with a previous episode of pericarditis with severe PE was admitted for acute pericarditis. Three days before, she was evaluated at the emergency department and presented normal laboratory workup and no significant findings in the transthoracic echocardiogram (TTE). A new TTE showed severe PE and laboratory work-up showed low haemoglobin levels. Fifteen days later, due to slow evolution, a left anterior mini-thoracotomy pericardial window procedure was performed finding minimal haemorrhagic PE with clots. We performed a complete work-up for a cause without significant findings and treated intensely to prevent recurrence or CP. DISCUSSION This is a case of recurrent haemorrhagic PE due to idiopathic pericarditis. Physicians should perform an intensive workup in order to find the cause because of its clinical implications and possible treatments. An intensive treatment must be initiated as soon as possible to prevent recurrence or CP.
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Affiliation(s)
- Ana Rivero
- Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Av. Reyes Catolicos, 2, Madrid, Spain
| | - Alvaro Aceña
- Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Av. Reyes Catolicos, 2, Madrid, Spain
- Autonomous University of Madrid, Ciudad Universitaria de Cantoblanco, Madrid, Spain
| | - Miguel Orejas
- Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Av. Reyes Catolicos, 2, Madrid, Spain
- Autonomous University of Madrid, Ciudad Universitaria de Cantoblanco, Madrid, Spain
| | - Rafael Hernandez-Estefania
- Cardiovascular Surgery Department, IIS-Fundación Jiménez Díaz University Hospital, Av. Reyes Católicos 2, Madrid, Spain
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Miranda WR, Hagler DJ, Reeder GS, Warnes CA, Connolly HM, Egbe AC, Taggart NW. Temporary balloon occlusion of atrial septal defects in suspected or documented left ventricular diastolic dysfunction: Hemodynamic and clinical findings. Catheter Cardiovasc Interv 2019; 93:1069-1075. [DOI: 10.1002/ccd.28150] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/29/2019] [Indexed: 11/09/2022]
Affiliation(s)
| | - Donald J. Hagler
- Department of Pediatric and Adolescent Medicine/Division of Pediatric CardiologyMayo Clinic Rochester Minnesota
| | - Guy S. Reeder
- Department of Cardiovascular MedicineMayo Clinic Rochester Minnesota
| | - Carole A. Warnes
- Department of Cardiovascular MedicineMayo Clinic Rochester Minnesota
| | - Heidi M. Connolly
- Department of Cardiovascular MedicineMayo Clinic Rochester Minnesota
| | - Alexander C. Egbe
- Department of Cardiovascular MedicineMayo Clinic Rochester Minnesota
| | - Nathaniel W. Taggart
- Department of Pediatric and Adolescent Medicine/Division of Pediatric CardiologyMayo Clinic Rochester Minnesota
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Ohri R, Salhiyyah K, Harding S, Ohri S. Pericardial calcification: A case report of a three-dimensional disease. Int J Surg Case Rep 2019; 57:152-154. [PMID: 30959364 PMCID: PMC6453799 DOI: 10.1016/j.ijscr.2019.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/22/2019] [Accepted: 03/11/2019] [Indexed: 01/27/2023] Open
Affiliation(s)
- Raja Ohri
- Wessex Cardiothoracic Centre, University Hospitals Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom
| | - Kareem Salhiyyah
- Wessex Cardiothoracic Centre, University Hospitals Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom.
| | - Stephen Harding
- Wessex Cardiothoracic Centre, University Hospitals Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom
| | - Sunil Ohri
- Wessex Cardiothoracic Centre, University Hospitals Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom
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49
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Tuck BC, Townsley MM. Clinical Update in Pericardial Diseases. J Cardiothorac Vasc Anesth 2019; 33:184-199. [DOI: 10.1053/j.jvca.2018.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Indexed: 01/15/2023]
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50
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Affiliation(s)
- Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - the University of Queensland School of Medicine, New Orleans, LA, United States of America.
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