ALERT!

This site is not optimized for Internet Explorer 8 (or older).

Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.

Surgical Treatment for Constrictive Pericarditis

Monday, September 2, 2024

By

Ahmad Abugameh

Abugameh A, Mashhour A, J. Rastan A. Surgical Treatment for Constrictive Pericarditis. August 2024. doi:10.25373/ctsnet.26882239

The conventional approach involved decorticating the left ventricle (LV) before the right ventricle (RV) to avoid pulmonary edema. The median sternotomy provided adequate access to the right ventricle, right atrium, and major vessels, including the caval-right atrial junctions, allowing for effective evacuation of the diseased pericardium from phrenic nerve to phrenic nerve. Sharp and blunt dissection methods were used to initiate the dissection in the middle of the body. At that point, care was taken to identify a separate plane between the epicardium and the fibrotic-constricted parietal pericardium while monitoring the coronary arteries. 

The dissection was then extended between the pericardium of the left and right ventricular walls and the left and right atrial walls to remove all stiff pericardial tissues. The lateral expansions of the dissection planes were approximately 1 cm anterior to the right and left phrenic nerves. Superiorly, the decortication continued to the major vessels, and inferiorly, it extended to the diaphragmatic surface and inferior vena cava. 

In the presented case, due to heavy calcification, the procedure was performed as an on-pump beating heart; otherwise, an off-pump technique would have been possible.  

References

  1. Depboylu BC, Mootoosamy P, Vistarini N, Testuz A, El-Hamamsy I, Cikirikcioglu M. Surgical Treatment of Constrictive Pericarditis. Tex Heart Inst J. 2017 Apr 1;44(2):101-106. doi: 10.14503/THIJ-16-5772. PMID: 28461794; PMCID: PMC5408622.
  2. Szabó G, Schmack B, Bulut C, Soós P, Weymann A, Stadtfeld S, Karck M. Constrictive pericarditis: risks, aetiologies and outcomes after total pericardiectomy: 24 years of experience. Eur J Cardiothorac Surg. 2013 Dec;44(6):1023-8; discussion 1028. doi: 10.1093/ejcts/ezt138. Epub 2013 Jun 12. PMID: 23761416.

Disclaimer

The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

Comments

Submitted by Allen James on
Thankyou Inflow ring constriction to the SVC and IVC has to be relieved. I usually do the right side without issues and just put on pump beating for the left side. This allows good access and avoids hypotension with a 20-30 minute cpb time.
Submitted by G. Jett on
The CTSNet article/video by Abugameh A, et al (Surgical Treatment for Constrictive Pericarditis. August 2024. doi:10.25373/ctsnet.26882239) is well done and describes pericardiectomy for calcified constrictive pericarditis utilizing median sternotomy and on-pump beating heart. Calcified constrictive pericarditis is technically difficult and may require median sternotomy and cardiopulmonary bypass as described. An alternative approach for pericardiectomy for non-calcified pericarditis is the robotic approach that we recently published in CTSNet (Jett GK, Nguyen AB, Squires JJ, Robinson K, Shih E. Total Robotic Pericardiectomy for Constrictive Pericarditis. December 2023. doi:10.25373/ctsnet.24747234). In addition, the authors illustrate phrenic nerve to phrenic nerve technique for pericardiectomy. Many believe that it is important to excise the pericardium from pulmonary vein to pulmonary vein rather than phrenic nerve to phrenic nerve because it more completely relieves any left sided pulmonary vein constriction. Patients have been referred to us following phrenic nerve to phrenic nerve pericardiectomy performed elsewhere which needed the pericardium posterior to the left phrenic nerve excised. Excision of the pericardium posterior to the left phrenic nerve is difficult with a median sternotomy but is more easily approached robotically. The robotic approach offers superior vision with a stable platform, resulting in more complete excision of the pericardium. The lateral decubitus position and bilateral approach are well tolerated and allow for complete pericardiectomy from pulmonary vein to pulmonary vein.

Add comment

Log in or register to post comments
Submit Content
Printer-friendlyPrinter-friendly

Rate article

Share

Twitter logo Facebook logo Google+ logo LinkedIn logo

Tags