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Presentation pattern and management of effusive-constrictive pericarditis in Ibadan.

Salami MA, Adeoye PO, Adegboye VO, Adebo OA - Cardiovasc J Afr (2012)

Bottom Line: Treatment of this disease is problematic because pericardiocentesis does not relieve the impaired filling of the heart and surgical removal of the visceral pericardium is challenging.They all improved following pericardiectomy.Hence our aim was to increase the sensitivity of others to issues raised and help spur on further collaborative studies to lay down guidelines with an African perspective.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Cardiovascular and Thoracic Surgery Division, University College Hospital and College of Medicine, University of Ibadan, Ibadan, Nigeria. drmudathirsalami@yahoo.com

ABSTRACT

Background: Effusive-constrictive pericarditis is a syndrome in which constriction by the visceral pericardium occurs in the presence of a dense effusion in a free pericardial space. Treatment of this disease is problematic because pericardiocentesis does not relieve the impaired filling of the heart and surgical removal of the visceral pericardium is challenging. We sought to provide further information by addressing the evolution and clinico-pathological pattern, and optimal surgical management of this disease.

Methods: We conducted a prospective review of a consecutive series of five patients managed in the cardiothoracic surgery unit of University College Hospital, Ibadan, in the previous year, along with a general overview of other cases managed over a seven-year period. This was followed by an extensive literature review with a special focus on Africa.

Results: The diagnosis of effusive-constrictive pericarditis was established on the basis of clinical findings of features of pericardial disease with evidence of pericardial effusion, and echocardiographic finding of constrictive physiology with or without radiological evidence of pericardial calcification. A review of our surgical records over the previous seven years revealed a prevalence of 13% among patients with pericardial disease of any type (11/86), 22% of patients presenting with effusive pericardial disease (11/50) and 35% who had had pericardiectomy for constrictive pericarditis (11/31). All five cases in this series were confirmed by a clinical scenario of non-resolving cardiac impairment despite adequate open pericardial drainage. They all improved following pericardiectomy.

Conclusion: Effusive-constrictive pericarditis as a subset of pericardial disease deserves closer study and individualisation of treatment. Evaluating patients suspected of having the disease affords clinicians the opportunity to integrate clinical features and non-invasive investigations with or without findings at pericardiostomy, to derive a management plan tailored to each patient. The limited number of patients in this series called for caution in generalisation. Hence our aim was to increase the sensitivity of others to issues raised and help spur on further collaborative studies to lay down guidelines with an African perspective.

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Radiograph showing evidence of pericardial calcification.
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Figure 2: Radiograph showing evidence of pericardial calcification.

Mentions: The patient underwent a subxiphoid tube pericardiostomy with pericardial biopsy. A postoperative chest radiograph showed evidence of pericardial calcification (Fig. 2). She was scheduled for an elective pericardiectomy, which was declined. The pericardiostomy tube was removed one week post operation. A subsequent radiograph revealed evidence of re-accumulation of pericardial fluid. The patient and her relatives still declined surgery and asked for a discharge.


Presentation pattern and management of effusive-constrictive pericarditis in Ibadan.

Salami MA, Adeoye PO, Adegboye VO, Adebo OA - Cardiovasc J Afr (2012)

Radiograph showing evidence of pericardial calcification.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3721937&req=5

Figure 2: Radiograph showing evidence of pericardial calcification.
Mentions: The patient underwent a subxiphoid tube pericardiostomy with pericardial biopsy. A postoperative chest radiograph showed evidence of pericardial calcification (Fig. 2). She was scheduled for an elective pericardiectomy, which was declined. The pericardiostomy tube was removed one week post operation. A subsequent radiograph revealed evidence of re-accumulation of pericardial fluid. The patient and her relatives still declined surgery and asked for a discharge.

Bottom Line: Treatment of this disease is problematic because pericardiocentesis does not relieve the impaired filling of the heart and surgical removal of the visceral pericardium is challenging.They all improved following pericardiectomy.Hence our aim was to increase the sensitivity of others to issues raised and help spur on further collaborative studies to lay down guidelines with an African perspective.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Cardiovascular and Thoracic Surgery Division, University College Hospital and College of Medicine, University of Ibadan, Ibadan, Nigeria. drmudathirsalami@yahoo.com

ABSTRACT

Background: Effusive-constrictive pericarditis is a syndrome in which constriction by the visceral pericardium occurs in the presence of a dense effusion in a free pericardial space. Treatment of this disease is problematic because pericardiocentesis does not relieve the impaired filling of the heart and surgical removal of the visceral pericardium is challenging. We sought to provide further information by addressing the evolution and clinico-pathological pattern, and optimal surgical management of this disease.

Methods: We conducted a prospective review of a consecutive series of five patients managed in the cardiothoracic surgery unit of University College Hospital, Ibadan, in the previous year, along with a general overview of other cases managed over a seven-year period. This was followed by an extensive literature review with a special focus on Africa.

Results: The diagnosis of effusive-constrictive pericarditis was established on the basis of clinical findings of features of pericardial disease with evidence of pericardial effusion, and echocardiographic finding of constrictive physiology with or without radiological evidence of pericardial calcification. A review of our surgical records over the previous seven years revealed a prevalence of 13% among patients with pericardial disease of any type (11/86), 22% of patients presenting with effusive pericardial disease (11/50) and 35% who had had pericardiectomy for constrictive pericarditis (11/31). All five cases in this series were confirmed by a clinical scenario of non-resolving cardiac impairment despite adequate open pericardial drainage. They all improved following pericardiectomy.

Conclusion: Effusive-constrictive pericarditis as a subset of pericardial disease deserves closer study and individualisation of treatment. Evaluating patients suspected of having the disease affords clinicians the opportunity to integrate clinical features and non-invasive investigations with or without findings at pericardiostomy, to derive a management plan tailored to each patient. The limited number of patients in this series called for caution in generalisation. Hence our aim was to increase the sensitivity of others to issues raised and help spur on further collaborative studies to lay down guidelines with an African perspective.

Show MeSH
Related in: MedlinePlus