Our Summary

This study looks into why some patients experience a worsening of a heart condition called tricuspid regurgitation (TR) after a specific heart surgery, called pericardiectomy. This surgery is done for patients with constrictive pericarditis, a condition where the protective sac around the heart becomes tight and stiff, affecting the heart’s function.

In simple terms, tricuspid regurgitation means the tricuspid valve, which separates two of the heart’s chambers, doesn’t close properly. This causes blood to flow back into the heart when it should be flowing out to the rest of the body.

The researchers analyzed data from 381 patients who had this surgery between 2000 and 2017. They found that about half of these patients had a worsening of their TR after the surgery. Those with worsening TR were more likely to have a history of heart failure, a larger-than-normal left atrium (one of the heart’s chambers), decreased right ventricle function (another heart chamber), and worsening mitral regurgitation (a similar issue to TR but with a different heart valve).

The researchers also found some evidence suggesting that patients with worsening TR might have a lower survival rate, especially if their TR didn’t improve within the first year after surgery.

Overall, the findings indicate that doctors should carefully monitor patients who have had a pericardiectomy, especially if they show signs of worsening TR. The study also highlights some factors that could indicate a higher risk for worsening TR, which can help doctors identify and manage these high-risk patients.

FAQs

  1. What is tricuspid regurgitation (TR) and how does it affect the heart’s function?
  2. What factors were found to potentially increase the risk of worsening TR after a pericardiectomy?
  3. How does worsening TR after a pericardiectomy potentially affect patient survival rates?

Doctor’s Tip

One helpful tip a doctor might tell a patient about pericardiectomy is to closely follow up with their healthcare provider for regular check-ups and monitoring of their heart condition, especially for signs of worsening tricuspid regurgitation. It’s important to report any new symptoms or changes in your health to your doctor promptly so that they can adjust your treatment plan accordingly. Additionally, maintaining a healthy lifestyle with regular exercise, a balanced diet, and proper medication adherence can help improve overall heart health and reduce the risk of complications post-surgery.

Suitable For

Patients who are typically recommended for pericardiectomy are those with constrictive pericarditis, a condition where the sac around the heart becomes tight and stiff, affecting heart function. These patients may experience symptoms such as shortness of breath, fatigue, and swelling in the legs and abdomen.

In addition, patients with worsening tricuspid regurgitation (TR) after pericardiectomy may have a history of heart failure, a larger-than-normal left atrium, decreased right ventricle function, and worsening mitral regurgitation. These patients may be at a higher risk for complications and should be carefully monitored by their healthcare team.

Overall, pericardiectomy is recommended for patients with constrictive pericarditis who are experiencing symptoms and complications related to this condition. Patients with worsening TR after the surgery may require additional monitoring and management to ensure optimal outcomes.

Timeline

  • Before pericardiectomy: Patients with constrictive pericarditis experience symptoms such as shortness of breath, fatigue, swelling in the legs, and chest pain. They undergo tests and evaluations to confirm the diagnosis and determine if surgery is necessary.

  • During pericardiectomy: The surgery is performed to remove the stiffened pericardial sac around the heart, allowing the heart to function properly. The procedure involves opening the chest cavity, removing the pericardium, and closing the chest back up.

  • After pericardiectomy: Patients are monitored closely for any complications or changes in their condition. Some patients may experience a worsening of tricuspid regurgitation, leading to symptoms such as fatigue, shortness of breath, and swelling. Further evaluations and treatments may be necessary to manage this complication and improve the patient’s outcomes.

  • Long-term outcomes: Patients who experience worsening tricuspid regurgitation after pericardiectomy may have a lower survival rate, especially if the issue persists beyond the first year post-surgery. Close monitoring and management of these patients are essential to ensure the best possible outcomes.

What to Ask Your Doctor

Some questions a patient should ask their doctor about pericardiectomy and potential complications such as worsening tricuspid regurgitation include:

  1. What is my risk of experiencing worsening tricuspid regurgitation after a pericardiectomy?
  2. What are the signs and symptoms of worsening tricuspid regurgitation that I should watch out for?
  3. How will my tricuspid regurgitation be monitored and managed after the surgery?
  4. Are there any specific factors in my medical history or test results that increase my risk of worsening tricuspid regurgitation?
  5. What can be done to improve or prevent worsening tricuspid regurgitation if it occurs after the surgery?
  6. How often will I need follow-up appointments or tests to monitor my heart health post-pericardiectomy?
  7. What is the expected recovery time after a pericardiectomy, and how will my heart function be assessed during this recovery period?
  8. Are there any lifestyle changes or medications that can help reduce the risk of complications like worsening tricuspid regurgitation after the surgery?
  9. What should I do if I notice any new or worsening symptoms related to my heart health after the surgery?
  10. What is the long-term outlook for patients who experience worsening tricuspid regurgitation post-pericardiectomy, and what steps can be taken to improve outcomes in these cases?

Reference

Authors: Tabucanon RS, Wang TKM, Chetrit M, Furqan MM, Chan N, Pande A, Jellis CL, Cremer PC, Kwon DH, Johnston D, Klein AL. Journal: Circ Cardiovasc Imaging. 2021 Oct;14(10):e012948. doi: 10.1161/CIRCIMAGING.121.012948. Epub 2021 Oct 5. PMID: 34607446