Our Summary

This research paper is about a specific heart condition called constrictive pericarditis. This is when the protective sack around your heart (the pericardium) becomes inflamed and stiff, causing symptoms similar to heart failure. The only real solution to this problem is to surgically remove the pericardium. The paper talks about how doctors can use a specific type of ultrasound (echocardiography) to diagnose the condition when the patient is breathing normally. However, there’s not a lot of information on how to use this ultrasound technique when the patient is on a ventilator.

The research also discusses using a technique called hepatic venous Doppler flow during surgery. This technique uses ultrasound to look at the blood flow in the liver’s veins to measure the severity of another heart issue (tricuspid regurgitation) that can occur with constrictive pericarditis. The authors used this technique to observe the improvement in a patient’s heart function (specifically, the phase of the heartbeat when the heart muscle is relaxed and filling with blood) after the surgical removal of the pericardium. The results showed a significant improvement in blood flow in the liver’s veins after the surgery, suggesting that the surgery was successful in relieving the high pressure in the right side of the heart.

FAQs

  1. What is constrictive pericarditis and how is it treated?
  2. How is the severity of constrictive pericarditis assessed during surgery?
  3. What does a blunted diastolic flow pattern in the hepatic vein indicate in a patient with pericarditis?

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 physical activity as advised by the healthcare team. It is important to monitor for any signs of infection, bleeding, or other complications and to seek medical attention if any concerning symptoms arise. It is also important to maintain a healthy lifestyle, including a balanced diet and regular exercise, to support recovery and overall heart health.

Suitable For

Patients who are typically recommended for pericardiectomy include those with constrictive pericarditis who are experiencing symptoms of heart failure. This may include patients with severe inflammation and fibrosis of the pericardium leading to impaired diastolic function. In some cases, patients may also have severe tricuspid regurgitation that needs to be assessed intraoperatively. Pericardiectomy is considered the only effective treatment for constrictive pericarditis, and it is usually recommended for patients who have failed conservative management or are experiencing severe symptoms that significantly impact their quality of life.

Timeline

Before pericardiectomy:

  • Patient experiences symptoms of heart failure such as shortness of breath, fatigue, and swelling in the legs and abdomen
  • Diagnosis of constrictive pericarditis is made through echocardiography and other imaging tests
  • Patient may undergo medical management to control symptoms, but surgery is ultimately required for definitive treatment

After pericardiectomy:

  • Patient undergoes the surgical procedure to remove the constricting pericardium
  • Improvement in symptoms of heart failure is expected post-operatively
  • Assessment of diastolic function with hepatic venous Doppler flow may show improvement in right atrial pressure
  • Patient may require follow-up appointments and monitoring to ensure proper recovery and long-term management of symptoms

What to Ask Your Doctor

Some questions a patient should ask their doctor about pericardiectomy may include:

  1. What is the purpose of a pericardiectomy?
  2. What are the potential risks and complications associated with the surgery?
  3. How long is the recovery period after a pericardiectomy?
  4. Will I need any follow-up care or medication after the surgery?
  5. What are the chances of the symptoms returning after the surgery?
  6. How will my quality of life be affected after the surgery?
  7. Are there any alternative treatments to consider before undergoing a pericardiectomy?
  8. How experienced is the surgical team in performing pericardiectomies?
  9. What are the success rates for pericardiectomy in treating constrictive pericarditis?
  10. Are there any lifestyle changes I should make before or after the surgery to improve the outcome?

Reference

Authors: Helwani MA, Alber S, DeWet CJ, Zoller JK. Journal: J Cardiothorac Vasc Anesth. 2020 Apr;34(4):1099-1102. doi: 10.1053/j.jvca.2019.11.011. Epub 2019 Nov 19. PMID: 31919002