Our Summary

This research paper is about a surgical procedure known as pericardiectomy, which is the standard treatment for a condition called constrictive pericarditis. However, a common problem after this surgery is failure of the right side of the heart (the right ventricle) due to a sudden increase in the amount of blood it has to pump.

To help with this, a device called Impella RP is used. This device is inserted through the skin and helps to take over the work of the right ventricle, providing support and helping to stabilize the patient’s blood flow and organ function.

In this paper, the authors discuss a case where a patient experienced acute right ventricular failure after a pericardiectomy. The patient had an Impella RP device implanted, which provided support for six days before being successfully removed.

FAQs

  1. What is the accepted treatment for patients with constrictive pericarditis?
  2. What is the Impella RP device used for in the postoperative period of a pericardiectomy?
  3. How long was the Impella RP device used in the reported patient case?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pericardiectomy is to be aware of the possibility of developing right ventricular failure after the surgery. It is important to monitor for symptoms such as shortness of breath, chest pain, and swelling in the legs, and to seek medical attention promptly if any concerning symptoms arise. In some cases, additional support such as the implantation of an Impella RP device may be necessary to help the right ventricle function properly and recover from the surgery.

Suitable For

Patients with constrictive pericarditis who develop acute right ventricular failure in the early postoperative period of pericardiectomy are typically recommended for Impella RP implantation. This device can provide enough support to achieve hemodynamical stability and recover end-organ function in these patients.

Timeline

  • Before pericardiectomy: The patient may experience symptoms such as shortness of breath, chest pain, fatigue, and swelling in the legs due to constrictive pericarditis. Diagnostic tests such as echocardiogram, MRI, and CT scan may be performed to confirm the diagnosis.

  • Pericardiectomy surgery: The patient undergoes surgical removal of the pericardium to relieve the constriction around the heart. The surgery is performed under general anesthesia and may involve a sternotomy or minimally invasive approach.

  • After pericardiectomy: In the early postoperative period, the patient may develop complications such as acute right ventricular failure due to sudden volume overload. To address this complication, the patient undergoes the implantation of an Impella RP device to support the right ventricle and maintain hemodynamic stability.

  • Recovery: With the support of the Impella RP device, the patient’s right ventricular function improves, and end-organ perfusion is restored. After 6 days of support, the Impella RP device is successfully explanted, and the patient continues to recover from the pericardiectomy surgery.

  • Follow-up: The patient undergoes regular follow-up appointments with their healthcare provider to monitor their recovery, manage any residual symptoms, and ensure long-term cardiovascular health.

What to Ask Your Doctor

  1. What is a pericardiectomy and why is it necessary for my condition?

  2. What are the potential risks and complications associated with pericardiectomy surgery?

  3. How long is the recovery process after a pericardiectomy?

  4. How likely am I to develop right ventricular failure after the surgery?

  5. What are the symptoms of right ventricular failure and how is it treated?

  6. How is Impella RP used to treat right ventricular failure in patients who have undergone pericardiectomy?

  7. What is the success rate of using Impella RP in patients with acute right ventricular failure after pericardiectomy?

  8. What is the expected duration of support with Impella RP in cases of right ventricular failure post-pericardiectomy?

  9. Are there any long-term effects or complications associated with the use of Impella RP in this situation?

  10. What follow-up care or monitoring will be necessary after the use of Impella RP for right ventricular failure following pericardiectomy?

Reference

Authors: Monteagudo-Vela M, Farmidi A, Panoulas V, Bhudia SK. Journal: Cardiovasc Revasc Med. 2021 Jul;28S:176-179. doi: 10.1016/j.carrev.2021.02.016. Epub 2021 Feb 15. PMID: 33627297