The changing spectrum of pericardiectomy for chronic pericarditis: occult constrictive pericarditis
Kilman, J.W.; Bush, C.A.; Wooley, C.F.; Stang, J.M.; Teply, J.; Baba, N.
Journal of Thoracic and Cardiovascular Surgery 74(5): 668-673
1977
ISSN/ISBN: 0022-5223 PMID: 916709 Document Number: 121667
During the past 24 yr 71 patients had a total pericardiectomy. Patients (59) had the classic findings of constrictive pericarditis as the reason for operation, and the operative mortality rate was 5% in this group. During the past few years a new indication for total pericardiectomy was found in 12 patients. These patients have fatigue, dyspnea and chronic chest pain without any of the other classic findings of chronic constriction. Coronary angiograms were normal. Cardiac catheterization following administration of a fluid load of 1000 cc [cm3] of warm normal saline during 6-8 min resulted in diastolic equilibration of pressures, constrictive pulse pressure contours and loss of the normal right atrial response to inspiration in all of these patients with occult constrictive pericarditis but in none of the 6 normal control subjects. Total pericardiectomy was done with ease in this group with no morbidity or deaths. Relief of the symptoms were dramatic. Repeat cardiac catheterization following total pericardiectomy revealed normal hemodynamics prior to and following fluid load. Tissue examination of the removed pericardium revealed gross and/or microscopic changes of inflammatory disease without calcification. Occult constrictive pericarditis appears to be a new indication for total pericardiectomy and can be defined only by the hemodynamic response to a rapid saline load.