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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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Potential algorithm for the management of effusive–constrictive pericarditis.
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Figure 5: Potential algorithm for the management of effusive–constrictive pericarditis.

Mentions: One can propose a management algorithm from the above discussion (Fig. 5). We would suggest pericardiocentesis followed by pericardiostomy and pericardial biopsy for bacteriology and histology as a first step in patients with tamponade or imminent tamponade. Duration of illness should be the next guide in those without tamponade, with those patients with duration more than one year offered pericardiostomy and biopsy. Other patients could be tried on medical treatment for six to eight weeks and operated on when there is persistent evidence of constriction. Presence of pericardial thickening with calcification following pericardiocentesis is an absolute indicator of need for a pericardiectomy. This can be further confirmed on a cardiac CT scan.


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

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

Potential algorithm for the management of effusive–constrictive pericarditis.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Potential algorithm for the management of effusive–constrictive pericarditis.
Mentions: One can propose a management algorithm from the above discussion (Fig. 5). We would suggest pericardiocentesis followed by pericardiostomy and pericardial biopsy for bacteriology and histology as a first step in patients with tamponade or imminent tamponade. Duration of illness should be the next guide in those without tamponade, with those patients with duration more than one year offered pericardiostomy and biopsy. Other patients could be tried on medical treatment for six to eight weeks and operated on when there is persistent evidence of constriction. Presence of pericardial thickening with calcification following pericardiocentesis is an absolute indicator of need for a pericardiectomy. This can be further confirmed on a cardiac CT scan.

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