Early operative outcome of pericardiectomy for symptomatic chronic tuberculous constrictive pericarditis

  • Azam Jan Rehman Medical Institute Peshawar, Pakistan
  • Muhammad Imran College of Medical Technology, Ziauddin University, Karachi
  • Kunwar Muhammad Aqeel Karachi Institute of Heart Disease, Karachi
  • Muhammad Tariq Khan Rehman Medical Institute Peshawar, Pakistan
  • Sumreen Begum Stem Cells Research Laboratory, Sindh Institute of Urology and Transplantation (SIUT).
  • Amir Mohammad Rehman Medical Institute Peshawar, Pakistan
  • Syed Mumtaz Shah Rehman Medical Institute Peshawar, Pakistan
  • Imran Ali Tabba Heart Institute Karachi Pakistan
Keywords: Early Operative, Pericardiectomy, constrictive pericarditis, symptomatic chronic tuberculous

Abstract

Background: Pericardiectomy procedure is commonly indicated for constrictive pericarditis (CP). One of the most important clue to diagnosis of CP is the signs and symptoms of right-sided heart failure that are not completely explained by presence of pulmonary disease or left-ventricular failure. The aim of this study was to assess clinical data presentation and early operative outcomes of pericardiectomy performed for symptomatic chronic constrictive pericarditis who had failed maximal medical therapy.

Methodology: A retrospective analysis was carried out of consecutive constrictive pericarditis adult age patients who underwent pericardiectomy procedure from 2002 to 2012. The patients who had intraoperative diagnosis of other then constrictive pericarditis were excluded from further analysis. A total 51 patients were selected for this study. The preoperative assessment, intraoperative findings and postoperative course and outcome such as hospital stay, prolonge ICU stay, post-operative CPV etc. were evaluated.

Results: 43 males and 8 females were include in the study among them 41% gave history of previous (TB) and 35% were pediatric patients (teens, as shown less than 19 years). 8 patients had effusive type pericarditis. The preoperative findings revealed dyspnea 54%, Chest Pain 45% and persistent cough 31%. Furthermore, 43% patients had ascites and 41% with pleural effusion. The mean preoperative central venous pressure (CVP) was 20.5 respectively. The post-operative outcome was short hospital stay, the post-operative patients CVP was estimated 13.5 and the mean drop of CVP due to pericardiectomy was estimated 7 respectively.

Conclusion: The conclusive findings of our study revealed that among the patients of symptomatic chronic tuberculous CP, the timely pericardiectomy attempt can effectively improve the hemodynamics of the patient. The early pericardiectomy can also reduce the morbidity and mortality rate of these patients.

References

1) Noubiap, J. J., Agbor, V. N., Ndoadoumgue, A. L., Nkeck, J. R., Kamguia, A., Nyaga, U. F., & Ntsekhe, M. (2019). Epidemiology of pericardial diseases in Africa: a systematic scoping review. Heart, 105(3), 180-188.

2) Pasipanodya, J. G., Mubanga, M., Ntsekhe, M., Pandie, S., Magazi, B. T., Gumedze, F., ... & Mayosi, B. M. (2015). Tuberculous pericarditis is multibacillary and bacterial burden drives high mortality. EBioMedicine, 2(11), 1634-1639.
3) Muttath R, Andrews M, Prabhu D. Treatment outcome in new smear positive pulmonary tuberculosis patients with and without immunosuppression on RNTCP regimen: a comparative observational study. International Journal of Research in Medical Sciences. 2017 Feb;5(2):384.
4) Pusch T, Pasipanodya JG, Hall RG, Gumbo T. Therapy duration and long-term outcomes in extra-pulmonary tuberculosis. BMC infectious diseases. 2014 Dec;14(1):115.
5) Ristić AD, Simeunović DS, Đukić P, Kočica M, Božić V, Vujisić-Tešić B, Milinković I, Živković I, Kanjuh V, Seferović PM. Differential diagnosis and management of chronic pericarditis in the context of 2015 ESC guidelines on pericardial diseases. Srce i krvnisudovi. 2016; 35(1):32-5.
Published
2019-06-01
How to Cite
Jan, A., Imran, M., Aqeel, K. M., Khan, M. T., Begum, S., Mohammad, A., Shah, S. M., & Ali, I. (2019). Early operative outcome of pericardiectomy for symptomatic chronic tuberculous constrictive pericarditis. International Journal of Endorsing Health Science Research (IJEHSR), 7(2), 67-77. https://doi.org/10.29052/IJEHSR.v7.i2.2019.67-77