Our Summary

This research paper focuses on a heart condition called posttubercular constrictive pericarditis, which is common in developing countries. This condition is often caused by tuberculosis and is typically treated with a surgical procedure called a pericardiectomy. The surgery is considered risky and can lead to serious health problems.

The researchers looked at 130 patients who underwent this surgery from 2003 to 2013. Most of the patients were male, and the average age was around 23 years old. Almost all of the patients had symptoms of the disease and were in poor health. Most of them had been diagnosed with tuberculosis.

The researchers found that after the surgery, the patients’ heart pressure dropped significantly. However, the surgery was not without complications. About 8% of the patients died shortly after the surgery, and others experienced prolonged need for a ventilator, kidney problems, or new cases of irregular heartbeat.

The researchers also found that patients with a low ejection fraction (a measurement of how well the heart is pumping blood) and irregular heartbeat before the surgery were more likely to die shortly after the surgery.

In a follow-up check after one year, most of the patients were in better health, and their hearts were pumping blood more effectively. There were no cases of the heart condition returning.

In conclusion, the surgery can be beneficial for patients with this condition caused by an infection. However, patients with low ejection fraction, irregular heartbeat, poor health, and constrictive effusive pericarditis (a combination of fluid around the heart and a stiffening of the heart’s outer layer) may have a poorer outcome after the surgery.

FAQs

  1. What is the treatment of choice for posttubercular constrictive pericarditis?
  2. What were the results and complications following pericardiectomy procedures performed from 2003 to 2013?
  3. What factors were found to result in poor surgical outcomes for pericardiectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pericardiectomy is to closely follow post-operative care instructions, including taking prescribed medications, attending follow-up appointments, and reporting any unusual symptoms or complications to their healthcare provider promptly. It is also important for patients to maintain a healthy lifestyle, including regular exercise and a balanced diet, to support their recovery and overall heart health.

Suitable For

Patients who are typically recommended for pericardiectomy are those with symptomatic constrictive pericarditis, especially of tubercular origin. These patients are usually in New York Heart Association functional class III or IV and may have a history of tuberculosis or have received prior antitubercular treatment. Patients with low ejection fraction, preoperative atrial fibrillation, poor functional class, and constrictive effusive pericarditis may have a higher risk of mortality and poor surgical outcomes. Anterior pericardiectomy is the preferred surgical approach for these patients, with cardiopulmonary bypass used as needed. Following pericardiectomy, patients typically experience improvement in symptoms and functional class, with a low risk of recurrence of constriction from residual pericardium on long-term follow-up.

Timeline

Before pericardiectomy:

  • Patients experience symptoms such as shortness of breath, chest pain, and fatigue
  • Diagnosis is made based on symptoms, imaging studies, and sometimes histopathological examination
  • Patients may undergo treatment with medications such as antitubercular drugs
  • Surgery is considered when symptoms are severe and medication is not effective

After pericardiectomy:

  • Surgery is performed, with provision for cardiopulmonary bypass if needed
  • Central venous pressure decreases after surgery
  • Early mortality rate is 7.69%
  • Some patients require prolonged ventilation and may develop complications such as renal dysfunction and atrial fibrillation
  • Follow-up at 12 months shows improvement in symptoms and functional class, with no recurrence of constriction from residual pericardium
  • Factors such as low ejection fraction, preoperative atrial fibrillation, and poor functional class are associated with poor surgical outcomes

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 a pericardiectomy procedure?
  3. What is the expected recovery time after a pericardiectomy?
  4. Will I need to undergo any additional treatments or medications after the procedure?
  5. How often will I need follow-up appointments after the pericardiectomy?
  6. Are there any lifestyle changes or restrictions I should be aware of post-surgery?
  7. What are the signs and symptoms of potential complications that I should watch out for?
  8. Will I need any rehabilitation or physical therapy after the procedure?
  9. Are there any long-term effects of a pericardiectomy that I should be aware of?
  10. What is the success rate of pericardiectomy in cases of posttubercular constrictive pericarditis?

Reference

Authors: Acharya A, Koirala R, Rajbhandari N, Sharma J, Rajbanshi B. Journal: Ann Thorac Surg. 2018 Oct;106(4):1178-1181. doi: 10.1016/j.athoracsur.2018.04.048. Epub 2018 May 16. PMID: 29777668