Our Summary

This study looked at the outcomes of two different procedures for recurrent chronic constrictive pericarditis, a heart condition where the pericardium (the sac around the heart) becomes inflamed and stiff. The two procedures examined were pericardiectomy (removal of the pericardium) via median sternotomy (a cut down the center of the chest) and left anterolateral thoracotomy (a cut on the left side of the chest).

The study included 24 patients who underwent one of the two procedures between July 2003 and July 2015. The results showed that both methods had similar mortality rates and both significantly improved the patients’ health status, as measured by the New York Heart Association (NYHA) functional class status.

However, there were differences in the type of complications from the procedures. The group that had the thoracotomy had a higher rate of lung infection, while the group that had the sternotomy had a higher rate of wound infections. Despite this, the study concluded that the thoracotomy was the preferred option as it avoided life-threatening sternal infections and was just as effective in improving the patients’ health status.

FAQs

  1. What is recurrent chronic constrictive pericarditis and how is it treated?
  2. What are the differences between pericardiectomy via median sternotomy and left anterolateral thoracotomy?
  3. What are the potential complications of these two procedures as shown in the study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pericardiectomy is to discuss with them the different surgical approaches, such as median sternotomy or left anterolateral thoracotomy, and the potential risks and benefits associated with each. It is important for the patient to be well-informed and involved in the decision-making process to ensure the best possible outcome. Additionally, patients should follow their doctor’s post-operative instructions carefully to minimize the risk of complications and promote a successful recovery.

Suitable For

Patients who are typically recommended for pericardiectomy include those with recurrent chronic constrictive pericarditis who have not responded to other treatments such as medications or pericardiocentesis (draining fluid from the pericardium). These patients may experience symptoms such as shortness of breath, chest pain, fatigue, and swelling in the legs and abdomen. Patients with severe symptoms and impaired heart function may benefit from pericardiectomy to improve their quality of life and overall prognosis.

Timeline

Before the pericardiectomy:

  1. Patient experiences symptoms of chronic constrictive pericarditis such as chest pain, shortness of breath, fatigue, and swelling in the legs.
  2. Patient undergoes diagnostic tests such as echocardiogram, MRI, and CT scans to confirm the diagnosis.
  3. Treatment options such as medications to reduce inflammation and fluid buildup are tried first.
  4. If conservative treatments are not effective, the patient may be recommended for pericardiectomy surgery.

After the pericardiectomy:

  1. Patient undergoes the pericardiectomy surgery, either via median sternotomy or left anterolateral thoracotomy.
  2. Post-surgery, patient is monitored in the hospital for complications and recovery.
  3. Patient undergoes rehabilitation to regain strength and function.
  4. Follow-up appointments with the healthcare team are scheduled to monitor the patient’s progress and adjust medications as needed.
  5. Patient experiences improvement in symptoms and overall health status as measured by NYHA functional class status.
  6. Long-term follow-up is needed to monitor for any potential complications or recurrence of symptoms.

What to Ask Your Doctor

  1. What is the purpose of a pericardiectomy for my condition?
  2. What are the potential risks and complications associated with pericardiectomy?
  3. How will the choice between median sternotomy and left anterolateral thoracotomy affect my recovery and overall health outcomes?
  4. What is the expected recovery time following a pericardiectomy procedure?
  5. Will I need any additional treatments or medications after the procedure?
  6. What can I expect in terms of pain management following the surgery?
  7. Are there any lifestyle changes or restrictions I should be aware of post-surgery?
  8. How frequently will I need follow-up appointments to monitor my progress?
  9. Are there any warning signs or symptoms I should watch for that may indicate a complication after the procedure?
  10. Are there any alternative treatment options for my condition that I should consider before proceeding with pericardiectomy?

Reference

Authors: Yunfei L, Tao L, Yongjun Q. Journal: J Cardiothorac Surg. 2019 Aug 22;14(1):152. doi: 10.1186/s13019-019-0978-8. PMID: 31439013