Constrictive pericarditis after cardiac surgery: Report of three cases and review of the literature

Cimino, John J.; Kogan, A.

doi:10.1016/0002-8703(89)90021-5

Cited by 47 publications

(16 citation statements)

References 36 publications

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“…5,6 Instead, the number of cases of post heart surgery constrictive pericarditis has increased 2-4 and factors associated with the development of constrictive pericarditis following surgery include postoperative sternal wound infection, pericardial contamination with the irrigating agent (notably povidone iodine and iced saline slush), air-drying postoperative hemopericardium [10][11][12][13] and insertion of a pericardial substitute. 14 None of the patients in this study had postoperative hemopericardium or was flushed with iodine solution.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Treatment of Constrictive Pericarditis in Taiwan

Chen

Lai

2005

Circ J

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onstrictive pericarditis, an uncommon disease, is a chronic fibrous thickening of the pericardium that prevents the normal diastolic filling of the heart. Surgery is the only satisfactory treatment. Many factors associated with the development of constrictive pericarditis have been identified, such as infection, post heart surgery, post mediastinal irradiation, but in Western countries the spectrum of etiology has shifted from infection, especially Mycobacterium tuberculosis (Tb), to post heart surgery, although idiopathic causes still predominate. [1][2][3][4] In endemic areas, however, Tb remains the most common cause of constrictive pericarditis. 5,6 Thirteen years experience of constrictive pericarditis patients who underwent total pericardiectomy in a university hospital located in a rural area of Taiwan were reviewed and the clinical characteristics, especially the etiological spectrum, and operative approach were analyzed. MethodsWe retrospectively analyzed the characteristics of 23 patients (19 males, 4 females, age range 25-65 years) who underwent total pericardiectomy for constrictive pericarditis between January 1990 and December 2003. Constrictive pericarditis was diagnosed by chest roentgenography (calcified pericardium), computed tomography scan (thickened pericardium and/or pleural effusion), 7 and confirmed by cardiac catheterization (elevated end-diastolic pressure and classic "square root sign" of right ventricular pressure tracing). 8,9 The etiological factors evaluated included underlying diseases, microbiological culture results, and histopathological findings. Tubercular pericarditis was diagnosed if the histopathological section of pericardium showed the granulomatous changes of Tb. Table 1 shows the clinical characteristics of the study group prior to operation. The most common symptoms were exertional dyspnea (96%), jugular vein distension (96%), hepatomegaly (70%), general fatigue (65%), peripheral edema (65%), and ascites (52%). Pathogens isolated in 11 patients (48%) were Tb in 8 patients (35%) and streptococcus in 2 patients (9%); 1 patient had strongyloidiasis Results Clinical Characteristics and Treatment of Constrictive Pericarditis in TaiwanRobert Fu-Chean Chen, MD; Cha-Po Lai, MD* Background Constrictive pericarditis is an uncommon disease that prevents the normal diastolic filling of the heart and pericardiectomy is the only satisfactory treatment. Methods and ResultsThe clinical characteristics and treatment of patients who underwent pericardiectomy for constrictive pericarditis (n=23) were reviewed. Surgery was performed via left anterolateral thoracotomy plus transsternal extension in 3 patients, and median sternotomy in 20 patients. There were 2 deaths, resulting in an overall mortality rate of 8.7%. Of the 23 patients, 8 had Mycobacterium tuberculosis (Tb) infection, 2 had streptococcus infection, 1 had strongyloidiasis (Strongyloides stercoralis) and 1 developed the condition after a myocardial infarction; 2 patients underwent pericardial substitute insertion as post-hea...

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Treatment of Constrictive Pericarditis in Taiwan

Chen

Lai

2005

Circ J

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“…CP following cardiac surgery is rare, with the incidence estimated to range from 0.2%-0.3%, 6) and only two cases (out of 1492 open heart surgeries from 2010 January to 2012 December: 0.13%) were found in our institute. In affected patients, echocardiography can demonstrate septal bounce, adhesion of the pericardium, and cyclic variations in mitral and tricuspid inflow during respiration.…”

Section: Discussionmentioning

confidence: 71%

Transient Constrictive Pericarditis Following Cardiac Surgery

Maeda

Saito

Toda

et al. 2014

ATCS

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Transient constrictive pericarditis (CP) is quite rare, with only a few reports presented. Herein, we report 2 cases of transient CP following cardiac surgery. Case 1 was an 80-year-old man who underwent repair of a left ventricular free wall rupture, while Case 2 was a 69-year-old woman who underwent a conventional aortic valve implantation procedure. In both cases, constrictive features developed about 2 weeks after surgery, which were treated successfully by administrations of non-steroidal anti-inflammatory drugs (NSAIDs). Prior to performing a pericardiectomy, NSAID administration should be considered for affected patients who are hemodynamically stable.

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“…Además, en nuestro caso fue interesante con vistas a la cirugía evacuadora para verificar la permeabilidad de los injertos de la cirugía coronaria previa. El diagnóstico diferencial debe hacerse con la pericarditis constrictiva posquirúrgica, que es un fenómeno poco frecuente con una incidencia del 0,2%-0,3% 8 . Sus principales síntomas son disnea (81%), dolor torácico (34%) y astenia (29%) y como signos físicos: edemas periféricos (90%), aumento de la presión venosa yugular (86%).…”

Section: Discussionunclassified

Hematoma pericárdico dos años después de cirugía coronaria

Fuster¹,

Llorens²,

Melero³

et al. 1997

Revista Española de Cardiología

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INTRODUCCIÓNEl taponamiento cardíaco (TC) tras cirugía cardíaca es una complicación poco frecuente, pero con un riesgo elevado. Según las distintas series su incidencia oscila entre el 0,5% y el 5,8% 1,2 . Su mortalidad se cifra en un 18% 2 . La mayoría se presentan en la fase precoz desarrollándose en las primeras horas o días del postoperatorio; pero también pueden aparecer en los días subsiguientes. De forma arbitraria se ha definido el TC tardío como aquel que se presenta más allá del séptimo día del postoperatorio, habiéndose referido hasta los 6 meses tras la intervención 2 . Ajustándose a esta definición su incidencia sería de un 0,3-2,6%. El hecho de plantear dificultades diagnósticas puede repercutir negativamente en su pronóstico 2 .Reseñamos un caso de aparición inusualmente tardía, tratando de aportar el enfoque diagnóstico y terapéutico que pensamos más apropiado. CASO CLÍNICOVarón de 65 años intervenido de triple bypass aortocoronario en enero de 1993, realizándose con vena safena a marginal izquierda, arteria mamaria interna izquierda a descendente anterior y mamaria derecha a la descendente posterior. El pericardio no fue cerrado al finalizar y se colocaron un drenaje retrosternal y otro pleural izquierdo, que fueron retirados a las 45 horas. El sangrado postoperatorio total fue de 1.045 ml. Fue dado de alta el octavo día con tratamiento antiagregante (aspirina 125 mg diarios) que se mantuvo durante 22 meses. A los 5 meses de la intervención pre- El taponamiento cardíaco tras cirugía cardíaca es una complicación que conlleva un riesgo elevado, que puede ocurrir tanto en el postoperatorio precoz como en el tardío. El taponamiento tardío se ha definido, de forma arbitraria, como aquel que ocurre más allá del séptimo día del postoperatorio. Son mucho menos frecuentes que los precoces y han sido referidos, en la mayoría de los casos, hasta seis meses después de la intervención. Suelen plantear problemas diagnósticos que pueden repercutir negativamente en el pronóstico. COMUNICACIONES BREVES Hematoma pericárdico dos años después de cirugía coronariaPor su atípica aparición, se presenta el caso de un paciente de 65 años que desarrolló un síndrome pospericardiotomía y posteriormente un hematoma pericárdico, tras casi dos años de una intervención de bypass aortocoronario. Se expone el caso y se realiza una revisión bibliográfica del taponamiento cardíaco postoperatorio tardío bajo un enfoque diagnóstico y terapéutico. PERICARDIAL HAEMATOMA TWO YEARS AFTER CORONARY SURGERYCardiac tamponade is a life-threatening complication after cardiac surgery which may develop in the early or late postoperative period. The latest have been defined arbitrarily as the ones ocurring after the 7th postoperative day. They are less common than the early ones and most of the cases have been reported up to six months after the operation. They usually determine diagnostic difficulties that can negatively influence the prognosis.Because of its atypical late appearance, a case of a 65 year old man is presented who developed a pos...

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Constrictive pericarditis after cardiac surgery: Report of three cases and review of the literature

Cited by 47 publications

References 36 publications

Clinical Characteristics and Treatment of Constrictive Pericarditis in Taiwan

Clinical Characteristics and Treatment of Constrictive Pericarditis in Taiwan

Transient Constrictive Pericarditis Following Cardiac Surgery

Hematoma pericárdico dos años después de cirugía coronaria

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