Our Summary

This study was conducted to investigate how a procedure called pericardiectomy, which involves removing the sac around the heart, impacts a patient’s heart function during and after surgery. The researchers used a new tool, called Flotrac/VigileoTM monitor, which uses arterial pressure waveform analysis. The study involved 30 patients between the ages of 15 and 55 who underwent this procedure.

The study found that for the majority of patients (73.33%), there was a significant decrease in right atrial pressure (pressure in the right upper chamber of the heart) and systemic vascular resistance index (a measure of resistance to blood flow in the body’s blood vessels) after the procedure. This was accompanied by an improvement in cardiac index (a measure of heart function) and oxygen delivery to the body.

However, the study also found that stroke volume (the amount of blood pumped out of the heart with each beat) and stroke volume variation (changes in stroke volume) did not increase as expected after the procedure. Patients with a condition called low cardiac output syndrome (where the heart doesn’t pump enough blood to meet the body’s needs) continued to have high central venous pressure (pressure in the veins that carry blood to the heart) and reduced cardiac index, along with abnormal characteristics of the heart’s filling during diastole (the phase of the heartbeat when the heart muscle relaxes and allows the chambers to fill with blood).

In conclusion, the researchers found that this procedure could help normalize heart function quickly and the new device could accurately assess the success of the procedure. However, they also found that stroke volume variation did not predict the need for fluid during and after the procedure.

FAQs

  1. What is a pericardiectomy and how is it performed in this study?
  2. What is the significance of the Flotrac/VigileoTM monitor in this study?
  3. What were the findings about stroke volume variation in patients who underwent pericardiectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pericardiectomy is to be aware that there may be improvements in hemodynamics, such as reduced right atrial pressure and systemic vascular resistance, along with improved cardiac index and oxygen delivery in the immediate and late postoperative period. However, it is important to note that stroke volume and stroke volume variation may not increase proportionately after surgery. Patients should also be aware that central venous pressure and cardiac index should be monitored closely, especially in cases of low cardiac output syndrome. The use of a semi-invasive arterial pressure waveform analysis device can help accurately assess the adequacy of the pericardiectomy.

Suitable For

Patients who may be recommended for pericardiectomy include those with constrictive pericarditis or other conditions causing constriction of the pericardium, such as recurrent pericarditis, pericardial effusion, or tumors affecting the pericardium. These patients may exhibit symptoms such as shortness of breath, chest pain, fatigue, and swelling in the legs, and may have abnormal findings on imaging studies such as echocardiography or cardiac MRI. Pericardiectomy is typically considered for patients who have not responded to medical management or other less invasive treatments.

Timeline

Before pericardiectomy:

  • Patient presents with symptoms such as chest pain, shortness of breath, and fatigue
  • Diagnosis of constrictive pericarditis is made based on clinical examination, imaging studies, and laboratory tests
  • Patient undergoes preoperative evaluation and preparation for surgery

After pericardiectomy:

  • Immediately after surgery, there is a reduction in right atrial pressure and systemic vascular resistance index, and an improvement in cardiac index and oxygen delivery
  • Hemodynamic evaluation is performed at regular intervals postoperatively to monitor the patient’s progress
  • Some patients may exhibit persistently high central venous pressure and abnormal diastolic filling characteristics, indicating low cardiac output syndrome
  • Overall, there is early normalization of hemodynamics following pericardiectomy, and the adequacy of the procedure can be accurately assessed using arterial pressure waveform analysis.

What to Ask Your Doctor

  1. What is the purpose of a pericardiectomy?
  2. How will the procedure be performed?
  3. What are the potential risks and complications associated with pericardiectomy?
  4. What is the expected recovery time and postoperative care?
  5. How will my hemodynamics be monitored during and after the procedure?
  6. How will the Flotrac/VigileoTM monitor help in evaluating my hemodynamics?
  7. What are the specific parameters that will be measured with the monitor?
  8. What changes in my hemodynamics can I expect immediately after the surgery and in the following days?
  9. How will you determine if the pericardiectomy was successful in improving my hemodynamics?
  10. What signs or symptoms should I watch for that may indicate a complication or inadequate response to the surgery?

Reference

Authors: Chowdhury UK, Kapoor PM, Rizvi A, Malik V, Seth S, Narang R, Kalaivani M, Singh SP, Selvam S. Journal: Ann Card Anaesth. 2017 Apr-Jun;20(2):169-177. doi: 10.4103/aca.ACA_98_16. PMID: 28393776