Our Summary

This study is about a one-year-old Chihuahua who was brought to the vet because she was having trouble breathing and her heart was bigger than normal as seen in chest X-rays. An ultrasound of her heart showed fluid around the heart and pressure on the heart due to this fluid. A CT scan showed more of this fluid in the chest and heart area, thickening of the heart’s protective layer, and a mass along the area between the lungs.

When the fluid was extracted from the heart, it showed signs of a severe infection with different types of bacteria that thrive without oxygen. To treat the infection, the vets performed surgery to remove most of the heart’s protective layer and part of the lung.

After the operation, an ultrasound showed increased pressure on the right side of the heart, which suggested a condition where the heart’s outer layer becomes stiff and affects its function. Ten days after the surgery, the dog was brought back for treatment of right-sided heart failure, and another surgery was performed to remove the outer layer of the heart.

The exact cause of the infection was not found, but it is suspected that a foreign object like a grass seed might have caused it. The dog recovered well, and a ten-year follow-up showed no signs of the heart problem. This case study shows that the surgeries performed were successful in treating the dog’s infection and heart condition.

FAQs

  1. What is pericardiectomy and why was it necessary in this case?
  2. What were the symptoms and the diagnostic procedures used to identify the condition of the Chihuahua?
  3. What was the cause of the septic pericarditis and constrictive epicarditis in this case and how was it treated?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pericardiectomy is to follow post-operative care instructions carefully, including taking prescribed medications, attending follow-up appointments, and gradually increasing activity levels as advised by your healthcare provider. It is also important to monitor for any signs of infection or complications and to seek medical attention if any concerns arise. Additionally, maintaining a healthy lifestyle with regular exercise and a balanced diet can help support overall cardiac health and recovery.

Suitable For

Patients who may be recommended for pericardiectomy include those with severe pericardial effusion, cardiac tamponade, constrictive pericarditis, or other conditions causing constriction of the heart. In this case report, the Chihuahua presented with septic pericarditis and constrictive epicarditis, leading to respiratory distress and right-sided heart failure. The dog underwent subtotal pericardiectomy and epicardiectomy to treat the conditions successfully. Pericardiectomy may be recommended for patients with similar conditions who do not respond to medical management or pericardiocentesis.

Timeline

Before Pericardiectomy:

  • Patient presented with respiratory distress and enlarged cardiac silhouette on thoracic radiographs
  • Echocardiogram revealed pericardial effusion and cardiac tamponade
  • Computed tomography showed marked pleural and pericardial effusion, thickening of the pericardium, and a mass along the mediastinum
  • Pericardial fluid obtained via pericardiocentesis showed suppurative inflammation with mixed anaerobic bacteria
  • Subtotal pericardiectomy and partial lung lobectomy performed to treat septic pericarditis

After Pericardiectomy:

  • Postoperative echocardiogram showed increased right-sided pressures consistent with constrictive epicarditis
  • 10 days post-surgery, patient re-presented for right-sided heart failure
  • Epicardectomy was performed to treat constrictive epicarditis
  • No definitive source of infection was identified, but a penetrating foreign body (e.g., grass awn) was suspected
  • Patient recovered and a 10-year follow-up revealed no evidence of constrictive pathology on echocardiogram

What to Ask Your Doctor

  1. What are the risks and potential complications of pericardiectomy surgery?
  2. What is the expected outcome and recovery time following pericardiectomy surgery?
  3. Will there be any long-term effects or restrictions after the surgery?
  4. How will the surgery affect the overall heart function and cardiac health of the patient?
  5. Are there any specific follow-up care or medications that will be necessary after the surgery?
  6. What signs or symptoms should I watch for that may indicate a complication or recurrence of pericardial effusion?
  7. Are there any lifestyle changes or dietary recommendations that should be followed post-surgery?
  8. Will there be a need for further imaging tests or monitoring of the heart post-surgery?
  9. What is the likelihood of a recurrence of pericardial effusion after pericardiectomy surgery?
  10. Are there any alternative treatment options or therapies that should be considered in conjunction with pericardiectomy surgery?

Reference

Authors: Mastorakis AN, Filliquist B. Journal: J Am Anim Hosp Assoc. 2023 Jul 1;59(4):198-202. doi: 10.5326/JAAHA-MS-7350. PMID: 37432788