Our Summary

This research paper discusses a complicated heart surgery performed on a patient who had previously undergone chest radiation and aortic valve replacement. The patient had a severe infection in his artificial heart valve and a heart condition called constrictive pericarditis. The procedure involved multiple steps, including cleaning the infected area, replacing three heart valves, and reconstructing a part of the heart called the intervalvular fibrosa.

During the surgery, the patient’s main heart artery was accidentally damaged, causing severe bleeding. The surgeons responded by cooling the patient to slow down the bleeding, and starting a heart-lung machine to take over the patient’s circulation. They then replaced the damaged artery with a synthetic graft.

The surgeons also placed a patch made from the patient’s own heart sac to reconstruct the intervalvular fibrosa, and used donated heart tissue to replace the infected aortic root. They then replaced the mitral and tricuspid valves with artificial ones made from animal tissue.

Because of continued bleeding, surgeons had to remove the patient’s entire pericardium, or heart sac, and left cotton packing inside the chest to help control the bleeding. Later, they closed the chest and implanted a permanent pacemaker to regulate the patient’s heart rhythm.

FAQs

  1. What is a pericardiectomy and when is it performed?
  2. What were the steps taken to control the bleeding during the procedure described in the article?
  3. Why was a permanent epicardial pacemaker implanted after the pericardiectomy?

Doctor’s Tip

A helpful tip that a doctor might give a patient about pericardiectomy is to follow post-operative care instructions closely, including taking prescribed medications, attending follow-up appointments, and avoiding strenuous activities until cleared by your healthcare provider. It is also important to report any new or worsening symptoms, such as chest pain or shortness of breath, to your doctor immediately. Proper wound care and infection prevention are crucial for a successful recovery after pericardiectomy.

Suitable For

Patients who may be recommended for pericardiectomy typically include those with constrictive pericarditis, recurrent pericarditis, or constrictive pericarditis following previous cardiac surgery. These patients may present with symptoms such as shortness of breath, chest pain, fatigue, and fluid retention. Pericardiectomy is a surgical procedure that involves the removal of part or all of the pericardium, the sac surrounding the heart. This can help improve cardiac function and alleviate symptoms in these patients.

Timeline

  • Patient presents with symptoms of prosthetic valve endocarditis, previous chest irradiation, and bicuspid aortic valve replacement
  • Diagnosis of constrictive pericarditis is made
  • Reconstruction of intervalvular fibrosa and triple valve replacement is planned
  • Secondary sternotomy is performed during surgery, resulting in injury to ascending aorta and life-threatening bleeding
  • Bleeding is controlled with cooling and circulatory arrest, ascending aorta is replaced with a Dacron graft
  • Intervalvular fibrosa is reconstructed using a folded pericardial patch
  • Aortic root replacement with cryopreserved homograft is performed
  • Mitral and tricuspid valves are replaced with tissue valve prostheses
  • Complete pericardiectomy is performed
  • Chest is left packed with cotton due to diffuse bleeding
  • Permanent epicardial pacemaker is implanted during delayed chest closure.

What to Ask Your Doctor

  1. What is the purpose of a pericardiectomy and why is it being recommended for me?
  2. What are the potential risks and complications associated with a pericardiectomy procedure?
  3. What is the recovery process like after a pericardiectomy and how long can I expect to be in the hospital?
  4. Will I need any follow-up appointments or tests after the procedure?
  5. Are there any lifestyle changes or restrictions I should be aware of post-pericardiectomy?
  6. How will a pericardiectomy impact my overall heart health and function?
  7. Are there any alternative treatment options to a pericardiectomy that I should consider?
  8. How experienced are you in performing pericardiectomy procedures and what is your success rate?
  9. Will I need any additional medications or therapies after the pericardiectomy?
  10. What should I do if I experience any concerning symptoms or complications after the procedure?

Reference

Authors: Fernández-Cisneros A, Ascaso M, Rovira I, Sandoval E, Quintana E. Journal: Multimed Man Cardiothorac Surg. 2020 Sep 25;2020. doi: 10.1510/mmcts.2020.052. PMID: 33000922