Our Summary

This research paper is about pericardial disease, a condition that affects the thin sac surrounding the heart. Patients with this disease often need treatments or surgeries. Thus, it is important for anesthesiologists to understand how this disease changes the body’s normal functioning and how it affects patients before, during, and after surgery.

Pericardial disease can have various effects on patients, ranging from no symptoms at all to severe, life-threatening conditions. A common issue in these patients is the impaired filling of the heart with blood during relaxation (diastole). The speed at which the disease develops largely determines how much this filling is affected and how severe the symptoms will be.

The paper reviews recent studies on how to diagnose, medically treat, and perform invasive procedures for common pericardial diseases from the viewpoint of a doctor who manages patient care around the time of surgery.

FAQs

  1. What is the impact of pericardial diseases on perioperative management?
  2. How does the rate of onset of pericardial pathology affect the severity of the disease presentation?
  3. What are some of the common pericardial syndromes and their invasive therapeutic procedures?

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 their healthcare team. It is important for patients to communicate any concerning symptoms or changes in their condition to their healthcare provider promptly.

Suitable For

Patients who are typically recommended pericardiectomy include those with severe constrictive pericarditis, recurrent pericardial effusions or tamponade, and chronic inflammatory pericardial diseases that do not respond to medical therapy. These patients may present with symptoms such as shortness of breath, chest pain, and fatigue, and may have evidence of impaired cardiac function on imaging studies. Pericardiectomy is a surgical procedure that involves the removal of the pericardium to relieve the constriction or compression of the heart, allowing for improved cardiac function and symptom relief. It is important for these patients to be carefully evaluated by a team of cardiologists, cardiac surgeons, and anesthesiologists to determine the appropriate course of treatment and to ensure optimal outcomes.

Timeline

Before pericardiectomy:

  1. Patient presents with symptoms such as chest pain, shortness of breath, palpitations, or fatigue.
  2. Diagnostic tests are performed, including echocardiogram, MRI, CT scan, and/or cardiac catheterization to confirm the presence of pericardial disease.
  3. Medical therapy may be initiated to manage symptoms and reduce inflammation, such as nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids.
  4. If symptoms are severe or do not improve with medical therapy, interventional procedures such as pericardiocentesis may be performed to drain excess fluid from the pericardial sac.

After pericardiectomy:

  1. Pericardiectomy is performed to remove part or all of the pericardium, typically in cases of constrictive pericarditis or recurrent pericardial effusions.
  2. Following surgery, the patient is monitored in the intensive care unit for hemodynamic stability and to manage postoperative complications such as bleeding, infection, or arrhythmias.
  3. Physical therapy and cardiac rehabilitation may be initiated to optimize recovery and improve cardiac function.
  4. Long-term follow-up care is necessary to monitor for recurrence of pericardial disease and to manage any complications that may arise.

What to Ask Your Doctor

  1. What is the underlying cause of my pericardial disease and how will a pericardiectomy help improve my symptoms?
  2. What are the potential risks and complications associated with a pericardiectomy procedure?
  3. What is the expected recovery time after a pericardiectomy surgery?
  4. Will I need any additional treatments or medications after the surgery?
  5. How often will I need follow-up appointments and monitoring after the surgery?
  6. Are there any lifestyle changes or restrictions I need to be aware of after a pericardiectomy?
  7. Are there any alternative treatment options to consider before proceeding with a pericardiectomy?
  8. How experienced is the surgical team in performing pericardiectomies and what is their success rate?
  9. Can you provide me with any resources or additional information about pericardial disease and pericardiectomy?

Reference

Authors: Tuck BC, Townsley MM. Journal: J Cardiothorac Vasc Anesth. 2019 Jan;33(1):184-199. doi: 10.1053/j.jvca.2018.04.003. Epub 2018 Apr 3. PMID: 29735219