Our Summary

This research paper discusses a study on patients with a rare heart condition called Constrictive Pericarditis (CP). This disease thickens the sac-like covering around the heart, which can cause problems such as right-sided heart failure. The common treatment is a surgery called pericardiectomy, but it can have serious risks and complications, including acute heart failure, bleeding, and irregular heart rhythms.

The researchers studied 66 patients with CP who had undergone pericardiectomy from July 2018 to May 2022. They found that most of these patients had other serious health conditions as well, such as heart failure and irregular heart rhythms. However, almost 76% of them were able to be taken off a ventilator within the first 24 hours after surgery, and nearly 97% survived to be discharged from the hospital.

The study suggests that the way anesthesia was managed during the surgery played a key role in the patients’ outcomes. This included a thorough understanding of the disease, advanced monitoring techniques, and the use of a specialized kind of ultrasound called transesophageal echocardiography (TEE) to guide the surgery.

FAQs

  1. What is the primary treatment option for constrictive pericarditis (CP)?
  2. What are common postoperative concerns after a pericardiectomy procedure?
  3. How important is anesthetic management in the outcome of pericardiectomy procedures?

Doctor’s Tip

One helpful tip a doctor might tell a patient about pericardiectomy is to make sure to follow all preoperative instructions given by the medical team, such as fasting before the procedure and discontinuing certain medications as directed. This can help minimize the risk of complications during and after the surgery. Additionally, it is important for the patient to communicate any concerns or questions they may have with their healthcare provider to ensure they are well-informed and prepared for the procedure.

Suitable For

Patients who are typically recommended for pericardiectomy are those with constrictive pericarditis who have significant symptoms such as right-sided heart failure, congestive hepatopathy, New York Heart Association Type III/IV heart failure, and atrial fibrillation. These patients may have failed medical management and are experiencing severe hemodynamic compromise. Anesthesia and perioperative management should be carefully planned and monitored to optimize outcomes in these high-risk patients.

Timeline

Before pericardiectomy:

  • Patients present with symptoms of right-sided heart failure, such as shortness of breath, fatigue, and swelling in the legs.
  • Diagnostic tests, such as echocardiography and cardiac MRI, are performed to confirm the diagnosis of constrictive pericarditis.
  • Patients may undergo medical management with diuretics and anti-inflammatory medications to manage symptoms and improve cardiac function.
  • Surgical consultation is obtained for consideration of pericardiectomy.

After pericardiectomy:

  • Patients undergo the surgical procedure to remove the thickened pericardium and improve cardiac function.
  • Patients are closely monitored in the intensive care unit postoperatively for complications such as acute heart failure, bleeding, and arrhythmias.
  • Advanced monitoring, including transesophageal echocardiography (TEE), is used to guide management and optimize hemodynamics.
  • Most patients are successfully extubated within the first 24 hours postoperatively.
  • The majority of patients survive to discharge, with a low overall mortality rate.

Overall, pericardiectomy can be a challenging procedure with high morbidity and mortality, but with careful anesthetic management and close monitoring, patients with constrictive pericarditis can have favorable outcomes.

What to Ask Your Doctor

  1. What is the purpose of a pericardiectomy in treating constrictive pericarditis?
  2. What are the potential risks and complications associated with a pericardiectomy procedure?
  3. How long is the recovery process after a pericardiectomy?
  4. What are the expected outcomes and success rates of a pericardiectomy for constrictive pericarditis?
  5. How will my condition be monitored and managed postoperatively?
  6. What kind of follow-up care will be needed after the pericardiectomy procedure?
  7. Are there any specific lifestyle changes or restrictions that I should be aware of after the surgery?
  8. How will the anesthetic management be tailored to my specific medical history and condition during the procedure?
  9. Will I need any additional tests or evaluations before undergoing a pericardiectomy?
  10. Are there any alternative treatment options or therapies available for constrictive pericarditis besides pericardiectomy?

Reference

Authors: Shi C, Dong C, Yao L, Weiss N, Liu H. Journal: BMC Anesthesiol. 2023 Jun 1;23(1):191. doi: 10.1186/s12871-023-02155-4. PMID: 37264299