Our Summary

This research paper is about a type of treatment for a heart condition called constrictive pericarditis. This condition happens when the sac-like covering around the heart (the pericardium) becomes stiff, which makes it difficult for the heart to function properly. The treatment, called pericardiectomy, involves removing parts of this covering. The results of this treatment can be influenced by how severe the patient’s heart problem was before the operation, the cause of the pericarditis, and how much of the pericardium was removed.

The paper suggests that this treatment has very good results for patients whose pericarditis has no known cause, or for those who developed pericarditis after previous heart surgery. However, the survival rate is lower for patients who developed pericarditis as a result of radiation treatment. This is mainly because radiation can have other negative effects on the heart, such as damage to the heart valves, the outer layer of the heart, and the heart muscle, where it may cause scarring that can lead to other heart problems.

FAQs

  1. What is pericardiectomy and what is it used to treat?
  2. What factors affect the outcomes of a pericardiectomy procedure?
  3. Why is survival reduced in patients with radiation-induced constrictive pericarditis after a pericardiectomy?

Doctor’s Tip

One 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 physical activity as advised by the medical team. It is important to monitor for any signs of infection or complications and to seek medical attention promptly if any concerns arise. Additionally, maintaining a healthy lifestyle with regular exercise and a balanced diet can help support recovery and overall heart health.

Suitable For

Patients with constrictive pericarditis who are experiencing severe right-sided heart failure symptoms, particularly those with idiopathic disease or pericarditis secondary to prior cardiac operations, are typically recommended for pericardiectomy. Patients with radiation-induced constrictive pericarditis may also be considered for pericardiectomy, although their survival outcomes may be reduced due to additional secondary effects of radiation on cardiac structures. Adequate pericardial resection during the procedure is important for optimal long-term outcomes.

Timeline

Before pericardiectomy:

  1. Patient presents with symptoms of constrictive pericarditis such as shortness of breath, chest pain, fatigue, and edema.
  2. Diagnostic tests such as echocardiography, cardiac MRI, and CT scans are performed to confirm the diagnosis.
  3. Medical management may be attempted initially with medications to reduce inflammation and improve symptoms.
  4. If symptoms persist or worsen, surgical consultation for pericardiectomy is considered.

After pericardiectomy:

  1. Pericardiectomy surgery is performed, typically through a median sternotomy, involving removal of the diaphragmatic and anterior pericardium.
  2. Post-operative recovery involves monitoring for complications such as infection, bleeding, and arrhythmias.
  3. Patients may require intensive care unit (ICU) stay and rehabilitation to regain strength and function.
  4. Follow-up appointments are scheduled to monitor for recurrence of symptoms and assess cardiac function.
  5. Long-term outcomes depend on the severity of right-sided heart failure preoperatively, the underlying cause of constrictive pericarditis, and the extent of pericardial resection.
  6. Patients with idiopathic disease or post-operative pericarditis tend to have excellent long-term outcomes, while those with radiation-induced constrictive pericarditis may have reduced survival due to secondary effects of radiation on the heart.

What to Ask Your Doctor

  1. What is the purpose of a pericardiectomy?
  2. What are the risks and potential complications associated with a pericardiectomy?
  3. How long is the recovery period after a pericardiectomy?
  4. What are the expected outcomes and success rates of a pericardiectomy?
  5. Will I need any additional treatments or medications after the procedure?
  6. How will a pericardiectomy affect my overall heart function and quality of life?
  7. Are there any specific lifestyle changes I should make before or after the surgery?
  8. How often will I need follow-up appointments after a pericardiectomy?
  9. Are there any restrictions on physical activity or diet that I should be aware of?
  10. What is the experience and success rate of the surgeon performing the pericardiectomy procedure?

Reference

Authors: Hemmati P, Greason KL, Schaff HV. Journal: Cardiol Clin. 2017 Nov;35(4):559-566. doi: 10.1016/j.ccl.2017.07.009. PMID: 29025547