Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3715_Библиотеки_им_академика_М_И_Перельмана

In this study, extensive pericardial calcication were present in 5 (41.7%) patients, spreading over the anterior and inferior surfaces of ventricles. Despite extensive calcication, total pericardiectomy could be achieved in all patients of the study group. However these patients required higher inotropic support in the imme­diate postoperative period to tide over low cardiac output syndrome. This may be explained by underlying myocardial damage or atrophy, secondary to long standing encasement and penetration of the myocardium by calcium spurs, and persistent inammation. In addition, other investigators have suggested possibility of residual constriction, brous invasion of the myocardium and myocardial altercation leading to abnormal ventricular compliance.

Studies assessing the extent of myocardial damage with two-dimensional speckle tracking echocardiography in constrictive pericarditis are limited. In a study by Sengupta and associates, longitudinal, radial, and circumferential mechanics of the left ventricle were quantied by two-dimensional speckle tracking echocardiogra­phy on 26 patients with constrictive pericarditis and 19 patients with restrictive

cardiomyopathy. Compared to controls, individuals with constrictive pericarditis had impaired left ventricle circumferential strain (ε) (base; −16± 6 vs −9± 6%; p<0.01) [194–196, 202]. Amaki and associates validated the usefulness of two­dimensional speckle tracking echocardiography and cardiac magnetic resonance imaging on 30 patients with restrictive cardiomyopathy and 28 patients with con­strictive pericarditis [3].

In addition to cardiac structures, computed tomography and magnetic resonance imaging allows examination of the entire mediastinum and lungs. Computed tomog­raphy and magnetic resonance images provide excellent anatomic delineation, and are superior to echocardiography in evaluation of pericardial calcication, localized pericardial effusion, pericardial mass, and asymmetric pericardial thickening [8,

The normal pericardium on computed tomography ranges between 0.7 mm and 3mm; the ability to measure accurately is dependent on reconstructed slide thick­ness. Computed tomography is highly accurate in estimating the thickness of the pericardium and dening the distribution of thickening [54, 72, 73, 85–92, 188].

The normal pericardium is identied as a curvilinear line of soft tissue density, whereas in chronic constrictive pericarditis the parietal pericardium may be 4–30mm thick. Although cardiac computed tomography is not a rst-line investiga­tion in patients with suspected constrictive pericarditis, it is useful in conrmation of diagnosis and preoperative planning for pericardiectomy including redo cases [85]. Pericardial thickness of 4 mm or more indicates abnormal thickening and, when accompanied by clinical ndings of congestive cardiac failure, is highly sug­gestive of chronic constrictive pericarditis [234, 235]. The distribution of pericardial thickening may be asymmetric located over the right heart or over the atrioventricu­lar groove [19, 22–24].

163–165]. Fluid displaced by the vigorous contraction of the left ventricle during