Chronic constrictive pericarditis
【Overview】Shi-Liang Xiao, Department of Cardiac Surgery, Wuhan Union Hospital
Chronic constrictive pericarditis is a chronic inflammatory process involving the pericardial wall layer and the dirty layer. It causes pericardial fibrosis and thickening, which restricts the diastolic activity of the heart, thus reducing the function of the heart.
Therapeutic measures]
The natural prognosis of constrictive pericarditis is poor after a period of treatment and rest without improvement. Somerville W suggests that once the signs and symptoms of chronic constrictive pericarditis are present, the patient will survive the loss of general activity. The patient’s life expectancy in terms of loss of general activity is approximately 5 to 15 years. The disease progresses rapidly, especially in children, when ascites, etc., is present. Some patients eventually die with circulatory failure or hepatic or renal insufficiency. Therefore, once the diagnosis is established, surgery is the fundamental treatment to remove the constricted pericardium in order to gradually restore the heart to function. The recovery of postoperative cardiac function depends on: (i) the selection of the appropriate timing of surgery, which is easier to peel off before the formation of fibrous calcification and also less myocardial damage; and (ii) the extent of pericardial peeling, whether the thickened pericardium on the bilateral ventricular surface can be completely removed. Surgery should be performed under relatively stable conditions. Therefore, adequate and rigorous preoperative medical treatment should be performed. In case of constrictive pericarditis caused by tuberculosis bacteria, systematic anti-tuberculosis medication should be given, and the operation should be performed after the body temperature, blood sedimentation and general nutritional status are close to normal or relatively stable.
Indications and contraindications of pericardial dissection
1. Indications
(1) If the diagnosis of constrictive pericarditis is clear, surgery should be performed.
(2) Patients in poor condition, such as little food, severe ascites, poor liver and kidney function, low plasma protein, heart rate above 120 beats/min, fast hematocrit, etc., should be treated conservatively. If the disease is stable and the condition is improving, pericardial dissection should be performed at an optional stage.
(3) For those with serious conditions and no significant improvement with conservative treatment, Hu Bingzhong et al. advocated early pericardial windowing to improve the systemic functional status, followed by pericardial resection.
2. Contraindications
(1) Elderly patients with severe heart and lung disease who cannot tolerate surgery.
(2) Those with mild symptoms and no progression of disease.