Our Summary

The research paper is about a condition called effusive-constrictive pericarditis (ECP). ECP happens when there’s fluid around the heart causing pressure and the outer layer of the heart is less flexible than it should be. One of the main signs of this condition is that the pressure in the right side of the heart remains high even after a procedure to remove the fluid (pericardiocentesis) has been done.

ECP is more common in cases where the pericarditis (inflammation of the outer layer of the heart) is caused by tuberculosis and less common when there’s no known cause. Detecting ECP can be done by looking at the heart’s structure and function using a technology called echocardiography, after the fluid-removing procedure.

There’s still not a lot of information available about the best way to treat ECP or what the outcome might be for patients. However, the paper suggests that the first approach to treatment should be using drugs that reduce inflammation. If those don’t work, then a surgical procedure to remove part of the outer layer of the heart (pericardiectomy) might be considered.

FAQs

  1. What is Effusive-constrictive pericarditis (ECP)?
  2. What is the first line of treatment for ECP and when should pericardiectomy be considered?
  3. How is Effusive-constrictive pericarditis diagnosed?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pericardiectomy is that it is a surgical procedure to remove the pericardium, the sac surrounding the heart. This procedure is typically reserved for cases of effusive-constrictive pericarditis that do not respond to other treatments. It is important to discuss the risks and benefits of pericardiectomy with your healthcare provider and follow their recommendations for post-operative care and rehabilitation.

Suitable For

Patients with effusive-constrictive pericarditis (ECP) are typically recommended for pericardiectomy. ECP is characterized by a hemodynamically significant pericardial effusion and decreased pericardial compliance, leading to elevated right atrial pressure post-pericardiocentesis. ECP is more common in tuberculous pericarditis and less common in idiopathic cases. Diagnosis of ECP traditionally involves invasive hemodynamics, but echocardiographic features post-pericardiocentesis can also identify ECP. Treatment typically involves anti-inflammatory agents as first-line therapy, with pericardiectomy reserved for refractory cases. Prognosis and optimal treatment strategies for ECP are still being researched.

Timeline

Before pericardiectomy:

  1. Patient presents with symptoms such as chest pain, shortness of breath, and fatigue.
  2. Diagnostic tests such as echocardiogram, CT scan, and MRI are performed to confirm the diagnosis of effusive-constrictive pericarditis.
  3. Pericardiocentesis may be performed to drain the pericardial effusion.
  4. If symptoms persist and right atrial pressure remains elevated after pericardiocentesis, a diagnosis of effusive-constrictive pericarditis is made.
  5. Anti-inflammatory agents are prescribed as the first line of treatment.

After pericardiectomy:

  1. Pericardiectomy surgery is performed to remove the constricting pericardium.
  2. Patient undergoes post-operative care and monitoring in the hospital.
  3. Symptoms such as chest pain and shortness of breath may improve gradually following surgery.
  4. Patient may require physical therapy and cardiac rehabilitation to regain strength and function.
  5. Long-term follow-up care is necessary to monitor for any recurrence of symptoms or complications.

What to Ask Your Doctor

  1. What is the reason for recommending a pericardiectomy in my case?
  2. What are the potential risks and complications associated with the surgery?
  3. What is the expected recovery time following a pericardiectomy?
  4. Are there any alternative treatments or therapies that I should consider before opting for surgery?
  5. How often do patients with effusive-constrictive pericarditis require a pericardiectomy?
  6. Will I need any further tests or evaluations before undergoing the surgery?
  7. What can I expect in terms of long-term outcomes and prognosis following a pericardiectomy?
  8. Are there any lifestyle changes or precautions I should take after the surgery to prevent recurrence of symptoms?
  9. How experienced is the medical team in performing pericardiectomies for effusive-constrictive pericarditis?
  10. Are there any support groups or resources available for patients undergoing a pericardiectomy for this condition?

Reference

Authors: Miranda WR, Oh JK. Journal: Cardiol Clin. 2017 Nov;35(4):551-558. doi: 10.1016/j.ccl.2017.07.008. PMID: 29025546