Our Summary

This research paper talks about a 61-year-old man who was suffering from constrictive pericarditis, a condition where the sac-like covering around the heart (pericardium) becomes stiff due to inflammation. This stiffness restricts the heart’s ability to function properly. The condition was diagnosed using various imaging techniques like an ultrasound of the heart (echocardiogram), a CT scan of the chest, and a type of MRI for the heart.

The man underwent a surgical procedure called pericardiectomy, where the stiff part of the pericardium is removed to allow the heart to function better. To prevent a serious condition called right ventricular failure (a state where the right side of the heart can’t pump enough blood to the lungs) after the surgery, the doctors decided to use a technique called venoarterial extracorporeal membrane oxygenation (ECMO).

ECMO is a treatment that uses a pump to circulate blood through an artificial lung back into the bloodstream, providing heart-lung bypass support outside of the body. The patient was kept on this ECMO treatment for four days after the surgery, and he remained stable with no further signs of right ventricular failure.

The research suggests that ECMO might be a useful additional treatment in preventing right ventricular failure in patients who are at high risk after undergoing pericardiectomy.

FAQs

  1. What is constrictive pericarditis and how is it diagnosed?
  2. How can venoarterial extracorporeal membrane oxygenation (ECMO) prevent right ventricular failure (RVF) after pericardiectomy?
  3. How long was the patient kept on ECMO postoperatively, and what were the results?

Doctor’s Tip

One helpful tip a doctor might tell a patient about pericardiectomy is to follow postoperative care instructions carefully, including taking prescribed medications, attending follow-up appointments, and avoiding strenuous activities until cleared by the doctor. It is also important to report any unusual symptoms or changes in condition to the doctor immediately.

Suitable For

Patients who are typically recommended for pericardiectomy include those with constrictive pericarditis, recurrent pericarditis, and chronic effusive pericarditis that is unresponsive to medical therapy. Pericardiectomy may also be recommended for patients with pericardial constriction causing hemodynamic compromise or symptoms that are refractory to medical management. Patients who are at high risk of developing right ventricular failure postoperatively may benefit from the use of venoarterial extracorporeal membrane oxygenation as an adjunct to prevent complications.

Timeline

  • Before pericardiectomy:
  1. Patient presents with symptoms such as shortness of breath, chest pain, fatigue, and edema.
  2. Diagnostic tests such as echocardiogram, computed tomography chest, and cardiac magnetic resonance imaging are performed to confirm the diagnosis of constrictive pericarditis.
  3. An elective decision is made for the patient to undergo pericardiectomy surgery.
  • After pericardiectomy:
  1. Immediately postoperatively, the patient is placed on venoarterial extracorporeal membrane oxygenation (ECMO) to prevent significant right ventricular failure.
  2. The patient remains on ECMO for 4 days in a stable condition, with no further signs of RVF.
  3. Venoarterial ECMO is used as an elective adjunct in cases at high risk of RVF following pericardiectomy.
  4. The patient undergoes postoperative monitoring and follow-up care to ensure successful recovery and resolution of symptoms related to constrictive pericarditis.

What to Ask Your Doctor

  1. What is the purpose of a pericardiectomy?
  2. How will the procedure be performed?
  3. What are the risks and potential complications of the surgery?
  4. How long is the recovery process expected to be?
  5. Will I need any special follow-up care after the procedure?
  6. What symptoms should I watch out for after the surgery?
  7. Are there any specific lifestyle changes I should make after the procedure?
  8. How will the pericardiectomy affect my overall heart health?
  9. Are there any alternative treatments or procedures available for my condition?
  10. How successful is a pericardiectomy in treating constrictive pericarditis?

Reference

Authors: Ahmad H, Porter R, Yusuff H, Roman M. Journal: Eur J Cardiothorac Surg. 2019 Sep 1;56(3):625-626. doi: 10.1093/ejcts/ezy491. PMID: 30689797