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(n=21, 5.3%), calcic constrictive pericarditis (n=4, 10.6%), recurrent constrictive pericarditis after partial pericardiectomy (n=9, 2.3%), and postsurgical constrictive pericarditis (n=9, 2.3%). Three hundred and twenty-eight (83%) patients
underwent total pericardiectomy via median sternotomy, and 57 (14.4%) patients
underwent partial pericardiectomy via left anterolateral thoracotomy.
Cardiopulmonary bypass was used in 7 (1.8%) cases because of perforation and
massive bleeding from the inferior cavoatrial junction, and pulmonary artery [16].
Operative and late mortalities were 7.6% and 4.9% respectively. At a mean follow- up of 17.9±0.3years (95% CI: 17.3–18.6), actuarial survival was 83.8%±0.04%
in the total pericardiectomy group and 73.9±0.06% in the partial pericardiectomy
group (log rank, p=0.004). At 17years, 96.3% survivors of total pericardiectomy
and 79.1% survivors of partial pericardiectomy were in NewYork Heart Association
I/II (p<0.001) [16].
Diastolic lling parameters remained abnormal in 54 (15.9%) of the total pericardiectomy and 35 (61.4%) of the partial pericardiectomy group in the immediate
postoperative period (p<0.001). At closing interval, 11 (3.7%) and 9 (20.9%) of the
respective groups continued to have abnormal diastolic lling pattern on Doppler
echocardiogram (p=0.004) [16].
This investigation concluded that total pericardiectomy is associated with lower
perioperative and late mortality, and confers signicant long-term advantage by providing superior haemodynamics that appear to be independent of the aetiology of
constrictive pericarditis [16].
Joseph Rubin while commenting on the above article goes on to write, “…in this
study, median sternotomy provided good exposure of the right atrium and the venae
cavae and enabled excellent clearance of the diseased pericardium. This approach
demonstrated enhanced safety, decreased mortality, less postoperative low output
syndrome, abbreviated hospitalization, and better long-term survival (log-rank,
p=0.0001) than that obtained via thoracotomy. In the event of inadvertent excessive
bleeding (n=7), the patient could easily be connected to cardiopulmonary bypass…”
The unstated conclusion is that the maximum benet for constrictive pericarditis, in
particular, is expected from total pericardiectomy, which is best achieved through a
median sternotomy and is very difcult if not impossible through a left anterior
thoracotomy.
Such is the stuff that allows rm conclusions. Chowdhury and colleagues have
the data that are supported by excellent statistical comparisons of the two
approaches. They can assert that median sternotomy is the approach of choice for
chronic constrictive pericarditis, calcic patches, and pericardial masses. They dispel the controversy to which they alluded about the choice of approach for constrictive disease. Also, they can state that left anterolateral thoracotomy should be
reserved for the surgery of pyogenic and effusive pericardial disease.” [16].
Despite total pericardiectomy, the operative mortality rate was 7.6% in our series
and 6–19% in several large series published after 1985 [16–19, 24, 25, 30–33, 39,
40, 44, 59, 60, 64, 67, 83, 91–93, 108], Unlike others, there was no correlation with
age, tuberculous aetiology, and advanced NYHA symptoms on late survival, presumably because of the young patient population and timely institution of
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21 Short- andLong-Term Results
chemotherapy and surgery [16–19, 24, 25, 30–34, 39, 40, 44, 59, 60, 64, 67–69, 77,
83, 91–93, 108],
Although median sternotomy approach allowed a more radical clearance of pericardium overlying the right atrium and cavo-atrial junctions. Furthermore, it is
impossible to excise the portion of pericardium posterior to the phrenic nerve using
this approach [16–19, 24, 25, 30–34, 39, 40, 44, 59, 60, 63, 64, 67, 68, 83, 91–
93, 108].
Part B: In an effort to decrease the perioperative mortality rates and postoperative low cardiac output syndrome, the author proceeded to perform several technical
modications of the conventional left anterolateral thoracotomy approach to achieve
further radical excision of the pericardium posterior to phrenic nerve and diaphragmatic pericardium without utilizing cardiopulmonary bypass [17, 18, 25–32].
The step-by-step technical details of median sternotomy (n=55) and the author’s
modication of left anterolateral thoracotomy (n=67) to achieve radical pericardiectomy without utilizing cardiopulmonary bypass have been alluded to in our previous publications and has been addressed in Chaps. 13, 14, 15, 17, 22, 23, 24, and 25
[17, 18, 25–30].
Part C: In a subsequent investigation by Chowdhury UK and colleagues, a series
of 127 consecutive patients (91 being male patients) aged between 4 and 72years
(median, 25 years; interquartile range, 18–38) underwent total pericardiectomy
using a modied left anterolateral thoracotomy without cardiopulmonary bypass
between 2005 and 2019 [25].
The authors sought to ascertain the short- and long-term results of total pericardiectomy for chronic constrictive pericarditis using a modied left anterolateral thoracotomy without cardiopulmonary bypass (UKC’s modication) on postoperative
low cardiac output, survival, and re-operations.
Patients with annular constrictive pericarditis (n=11), calcic pericardial patch
compressing predominantly the right atrium and right ventricular outow tract
(n=17), circumferential “cocoon” calcication encompassing all cardiac chambers
(n=9), calcic spurs penetrating the ventricular chambers (n=18), recurrent pericarditis after previous partial pericardiectomy (n=5), constrictive pericarditis after
mediastinal irradiation (n=4), extracardiac intrapericardial mass (n=5), previous
open heart surgery (n=3), and a gradient between the superior and inferior cavoatrial
junctions more than 2mm Hg (n=3) were preferably considered for median sternotomy approach and were considered contraindications for this approach. Median
sternotomy was preferred in this subset of patients for improved surgical exposure
and easy institution of cardiopulmonary bypass, if required for inadvertent cardiac
injury and bleeding.
By employing these modications, radical pericardiectomy was associated with
further reduction of hospital mortality from 7.6 to 2.9% (total pericardiectomy) and
reduction of postoperative low cardiac output syndrome from 69% (total pericardiectomy) to 26.8% (radical pericardiectomy) [16–19, 24, 25].
Part D: Among patients with low cardiac output syndrome following pericardiectomy, two male patients aged 18 and 19years respectively undergoing total pericardiectomy for chronic calcic constrictive pericarditis developed systemic
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ventricular failure unresponsive to medical management following surgery. The
failing circulation was successfully supported using intra-aortic balloon counterpulsation. The authors concluded that aortic counterpulsation facilitates recovery of
ventricular function and appears to be a reasonable alternative in select instances of
refractory cardiac failure following pericardiectomy [34].
Subsequent to the publication on the use of intra-aortic balloon counterpulsation
following pericardiectomy, 17 more patients were supported with intra-aortic balloon counterpulsation for failing postoperative hemodynamics with successful outcome (unpublished).
Part E: In a subsequent investigation, these investigators from All India Institute
of Medical Sciences prospectively evaluated the changes in Tissue Doppler Imaging
(TDI) at mitral and tricuspid annuli in patients undergoing pericardiectomy for
chronic constrictive pericarditis and identied the relationship (if any) of the TDIderived variables with the patient’s symptomatic status following surgery [35].
Fifty-four patients aged 7years to 70years (mean 31.0±16.8years) undergoing
pericardiectomy via median sternotomy for constrictive pericarditis were studied
for 24.4±10.8months (range 6–42months). They underwent Doppler ow velocity
and TDI studies. A generalized estimating equation was used to test the changes in
TDI-derived mitral and tricuspid annular velocities in postoperative period from the
baseline.
Despite congestive cardiac failure, all patients had normal left ventricular ejection fraction and increased medial mitral and tricuspid early diastolic septal velocity
(e′) with “annulus reversus”. This pattern of annular velocity improved maximally
in the immediate postoperative period. At closing interval, 10 (18.5%) patients continued to be in NewYork Heart Association class II; 9 of them continued to remain
in atrial brillation. There were no differences of TDI-derived systolic and diastolic
annular velocities of the mitral and tricuspid valves in the preoperative period
between symptomatic and asymptomatic patients.
The investigators concluded that preoperative atrial brillation is a predictor of
poor prognostic outcome following pericardiectomy. Tissue Doppler Imagingderived mitral and tricuspid annular velocities were non-predictors of postoperative
outcome following pericardiectomy. Tissue Doppler Imaging is a useful investigative modality for diagnosis of constrictive pericarditis; it is not a useful indicator for
postoperative evaluation [35].
Sankhyan LK and associates from All India Institute of Medical Sciences, New
Delhi evaluated twelve patients aged 7 years to 70 years (median 21; IQR:
19.75–26.5 years), undergoing pericardiectomy for constrictive pericarditis were
studied for 2–36months (median 19months). They underwent Doppler ow velocity, tissue Doppler imaging, and two-dimensional speckle echocardiographic studies [91].
The objective(s) of this study was to prospectively evaluate the changes in Tissue
Doppler Imaging (TDI) at mitral and tricuspid annuli, and two-dimensional speckle
tracking echocardiography in patients undergoing pericardiectomy for chronic constrictive pericarditis and identify the relationship (if any) of the TDI and speckle
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echocardiographic derived variables with the patient’s symptomatic status following surgery.
There was signicant statistical improvement in the Global circumferential strain
rather than in global longitudinal and global radial strain after pericardiectomy.
These investigators concluded that Tissue Doppler Imaging and speckle tracking
echocardiography are useful investigative modalities for serial evaluation of patients
undergoing pericardiectomy. It can be performed serially with a high degree of
reproducibility [91].
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21.15 Japanese Nationwide Outcome Study
Tokuda Y and associates evaluated the current results and the predictors of perioperative complications for pericardiectomy for constrictive pericarditis in Japan. A
total of 346 patients who underwent isolated pericardiectomy for constrictive pericarditis nationwide between 2008 and 2012 were identied from the Japan Adult
Cardiovascular Surgery Database which captured clinical data from 456 Japanese
hospitals [93].
The mean age was 65.7±11.7years, median 68.0years. Pericardiectomy was
performed using cardiopulmonary bypass in 100 (28.9%) patients. The approach
was through a median sternotomy in 311 (90%) patients, and through a left anterolateral thoracotomy in the remaining 35 (10%) patients. Perioperative mortality rate
was 10.0%, and the composite operative mortality or major morbidity (stroke, reoperation for bleeding, need for mechanical ventilation for more than 24hours postoperatively due to respiratory failure, renal failure requiring dialysis or mediastinitis)
was 15.0%. Cardiopulmonary bypass was used in 2.9% patients of the thoracotomy
group and, 31.8% of the sternotomy group (P<0.0001) [93].
These investigators concluded that pericardiectomy is associated with high morbidity and mortality rates. Careful consideration should be given to these risk factors in the process of patient selection and perioperative management.
21.16 German Series
In 2001, Omoto T and associates analysed their experience on 79 patients undergoing pericardiectomy for chronic constrictive pericarditis between 1985 and 1999 at
the German Heart Centre, North-Rhine-Westphalia, Germany. The median age was
56.6±2.5years, range 22 to 77years [72].
It is noteworthy that the subtotal and partial pericardiectomy were dened variably in their series. The extent of pericardial resection that had been termed ‘subtotal pericardiectomy’ by the investigators would now be called ‘total pericardiectomy’.
Most operations (77) were carried out using cardiopulmonary bypass, with subtotal
pericardiectomy in 75 patients. Perioperative cardiac-related mortality was 5%.
21.18 The Johns Hopkins Medical Institution, Baltimore, Maryland, USA
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During a mean follow-up of 47.52± 35.4 months, there were 15 (20%) deaths.
Improved functional capacity was recorded in 66/75 (88%) patients; 60 (80%)
patients were in NYHA I or II postoperatively. Actuarial survival rate at 1, 5 and
10years was 89.9 ± 3.4%, 74.9± 5.7%, and 55.4± 13.5% respectively. Female
gender, valvular heart disease, renal insufciency, concomitant coronary artery
bypass grafting and valvular heart surgery, preoperative ventricular end-diastolic
pressure>20mmHg were signicant negative predictors of long-term survival [72].
The aetiology of the pericardial disease was tuberculosis in 4, radiation induced
in 5, previous cardiac operation in 13, previous incomplete pericardiectomy in 4,
and unclear in 52 (66%) patients. These authors recommended routine cardiopulmonary bypass for performing pericardiectomy in all cases.
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21.17 Emory University, Atlanta, Georgia, USA
Miller JI and associates in 1981 reviewed their experience on 102 patients undergoing pericardiectomy between 1974 and 1980. The mean age was 5.8years (range 16
to 84years). The aetiology of chronic constrictive pericarditis was neoplastic (26),
uremic (21), post open-heart surgery (19), idiopathic (17), and tuberculosis (8). The
surgical approach was median sternotomy in 26 patients, left anterolateral thoracotomy in 72 patients, and subxiphoid approach in 4 patients. Only 2 patients
required cardiopulmonary bypass. Perioperative mortality was 8.8% [64].
These investigators concluded that, from a technical standpoint, all cases of predominant effusive-constrictive pericarditis should be approached through a left
anterolateral thoracotomy; all cases of constrictive pericarditis should be approached
through a median sternotomy with standby cardiopulmonary bypass; and a subxiphoid approach should the reserved for those patients too ill for the above or for
pericardial biopsy and pericardial drainage. Betadine should probably be avoided
for irrigation of the pericardial sac.
21.18 The Johns Hopkins Medical Institution, Baltimore,
Maryland, USA
In 2012 Timothy George and co-investigators evaluated their experience and
attempted to dene the impact of aetiology on outcomes in a cohort of 98 adult
patients undergoing pericardiectomy between 1995 and 2010 [40].
The mean age of the cohort was 50± 16 years. The most common aetiologies
were idiopathic (n=44), postoperative (n=30), and post-irradiation (n=17). Total
pericardiectomy was performed in 94 patients through a sternotomy (n=93), left
anterolateral thoracotomy (6), and bilateral thoracotomy in 2 patients. Thirty-three
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patients underwent redo sternotomy. Of 34 requiring cardiopulmonary bypass, 27
patients (79.2%) had concomitant cardiac anomalies [40].
At a median follow up of 4.0 (IQR: 1.3–7.4) years, there were 42 (42.7%) deaths
Overall, 1, 5, and 10years’ survival were 82.5%, 64.3% and 49.2% respectively.
Survival differed sharply by aetiology with idiopathic, post-operative, and postirradiation 5-year survivals of 79.8%, 55.9% and 11% respectively (p<0.0001). On
Cox regression analysis, only the need for cardiopulmonary bypass (hazard ratio
[HR]: 21.2, p<0.02) was predictive of 30-day mortality, while post-radiation aetiology (HR: 3.19, p<0.02) and hypoalbuminemia (HR: 0.57, p<0.03) were associated with increased 10-year mortality [40].
These authors concluded that post-radiation pericarditis, hypoalbuminemia, and
hyperbilirubinemia are signicant risk factors for decreased long-term survival.
Secondly, while the aetiologic spectrum has changed over time, these changes have
not affected outcomes [40].
21 Short- andLong-Term Results
21.19 US Nationwide Outcomes Study
Following Pericardiectomy
In 2013, Gopaldas RR and associates published a US nationwide inpatient- outcomes
study on 13,593 patients who underwent pericardiectomy between 1998 and 2008.
Pericardiectomy was performed for constrictive pericarditis (28%, n=3851), pericardial calcication (15%, n=2061), secondary malignancies (3%, n=456), adhesive pericarditis (2%, n=318), and other causes (40%, n=5461). Only 62% were
routinely discharged home [46].
They demonstrated that pericardiectomy was associated with a mortality of
7.5%. Cardiopulmonary bypass was required in 9.3% of cases. These investigators
concluded that, apart from age and gender, aetiology has a signicant impact on
surgical outcomes [46].
21.20 German Series (Second German Series)
In a series from 1970 to 1990 inclusive from University Hospital, Erlangen,
Germany by Tirilomis and colleagues, 71 consecutive patients with constrictive
pericarditis were reviewed. The mean age was 44.2±16.1years [98]. Preoperatively,
43.6% were in NYHA Class III and 35.2% in Class IV.The operative approach was
median sternotomy in 93% and left anterolateral thoracotomy in 7%. Perioperative
mortality was 5.6%. At a median follow-up of 70months (range, 1–159 months)
actuarial survival at 5, 10, 15 and 20 years was 84.6 ± 4.5%, 80.1 ± 5.3%,
70.5± 6.9%, and 65.8±7.9%, respectively. Of the 49 survivors, 23% belong to
NYHA Class I, 42% to Class II, 35% to Class III, and none in class IV.Negative
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predictors for survival were advanced functional class (p<0.01), low-voltage electrocardiogram (p<0.01), ascites (p<0.01), orthopnoea (p<0.05) and hyperbilirubinaemia (p<0.05) [98].
These investigators concluded that poor outcome relates to preoperative disability, the degree of constriction and myocardial involvement, and recommended early
pericardiectomy through a median sternotomy for good long-term results [98].
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21.21 The Johns Hopkins Medical Institutions, Baltimore,
Maryland, USA (Second Johns Hopkins Study)
In another series from Johns Hopkins Hospital, deValeria PA and associates analysed the record of 60 consecutive patients undergoing pericardiectomy between
1980 and 1990. The indication for operations was effusive-constrictive disease in 24
patients and constrictive pericarditis in 36 patients [36].
The operative approach for pericardiectomy was median sternotomy in 52 and
left anterolateral thoracotomy in 8 patients. Two patients required cardiopulmonary
bypass for dense adhesions, and 2 additional patients who underwent pericardiectomy in association of coronary artery bypass grafting. The perioperative mortality
was 4.2% and 5.6%, respectively for pericardial effusion and constriction respectively [36].
At a median follow-up of 56.9± 38.2 months, the actuarial survival at 1year,
5years and 10years was 82.1±5.1%, 71.7±6.7%, and 59.8±12.2% respectively.
Cox proportional hazard analysis revealed history of malignancy, previous cardiac
surgery, and advanced preoperative NYHA Class as predictors of poor survival.
They concluded that complete pericardiectomy can be performed safely with good
long-term functional results. Patients with effusive-constrictive disease that is resistant to conservative methods should undergo complete pericardiectomy rather than
a limited procedure. Patients with chest pain refractory to steroid therapy can be
relieved of symptoms with the operation [36].
21.22 Swedish Series
In a series from Karolinska Hospital, Sweden by Astudillo and Evert, 36 patients
with constrictive pericarditis from 1969 to 1984 inclusive were reviewed. Twentysix of 36 (72%) patients had pericardial calcication and 44% (n=16) were idiopathic. Left anterolateral thoracotomy was employed in 35 cases. Median sternotomy
was used in one patient due to extensive left pleural calcication. There were 3
(8.3%) early and 11 (30.5%) late deaths. Actuarial survival at 5 and 10years was
77% and 69% respectively [1].
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At a median follow-up of 8 (range 2–17years), 16 of 33 (49%) patients were
asymptomatic. Lack of postoperative improvement was related to severe, nonresectable calcications, and probably in some cases to associated brous pericarditis or restrictive myocardial disease. These investigators concluded that left
anterolateral thoracotomy permits easier and more complete left ventricular pericardiectomy, but is less safe when severe calcications involve the right ventricle and
right atrium [1].
21 Short- andLong-Term Results
21.23 Christian Medical College andHospital, Vellore
Series, India
In 1988, Basi VV and associates investigated a total of 118 patients who undergoing
pericardiectomy for constrictive pericarditis between 1954 and 1985 at Christian
Medical College and Hospital, Vellore, India. Ages ranged from 10 to 50 (mean
27±11.5) years. Aetiology of constrictive pericarditis was tuberculosis in 72 (61%)
of cases. Preoperatively, 97 (82.2%) patients were in NYHA class III or
IV. Pericardiectomy was accomplished through left anterolateral thoracotomy in
107 cases, median sternotomy in 3 cases, and bilateral thoracotomy in 8 cases [6].
Postoperative low cardiac output syndrome was present in 34 (28.8%) patients,
12 (35.3%) of whom died. Overall perioperative mortality was 16%. possibly
related to improvements in perioperative care.
Of the 99 survivors, 78 were followed from periods ranging from 2 to 30
(mean±SD, 9±6.5) years. Of the 72 patients in whom functional capacity could
be assessed, 59 were in NYHA class I, four in class II, and 9in class III.There were
6 cardiac-related deaths. None required re-operation for recurrent constriction.
These investigators concluded that poor results of pericardiectomy in some patients
are likely to be related to advanced preoperative disability, and recommended early
pericardiectomy, whenever possible [6].
21.24 Turkish Series
Yetkin U and associates in 2003 reviewed 42 consecutive cases of constrictive pericarditis undergoing pericardiectomy for chronic constrictive pericarditis between
1994 and 2002 [107]. The average age was 39.3years (range 17 to 63 years).
Pericardial calcication was present in 18 (42.9%) patients. Tuberculosis was associated with calcication in 16 of the 18 (88.8%) patients. All patients underwent
total pericardiectomy via median sternotomy. In 4 of 18 patients with calcic pericardial plaques, the investigators left large plaques that did not permit the development of a cleavage plane. In these cases, they performed wedge incisions that
reached the epicardium, which reduced the size of the plaques and reduced
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myocardial constrictions. No patient required cardiopulmonary bypass due to severe
calcication or adhesions. Five patients required cardiopulmonary bypass for additional cardiac surgery. Three patients required post-operative intra-aortic balloon
counterpulsation for low cardiac output syndrome.
Perioperative modality was 11.9%. Within 1month, the number of patients in
NYHA class IV moved from 18 (preoperative) to 1; in class III from 20 to 6, in class
II from 4 to 13, and in class I, from 0 to 22. These authors recommended a median
sternotomy approach for chronic constrictive pericarditis, and cardiopulmonary
bypass in indicated cases [107].
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21.25 Series fromTehran, Iran
Ghavidel AA and associates in 2012 reviewed their experience on 45 patients undergoing pericardiectomy between 1994 and 2006. The mean age was 46.6±14.9years
(range 21–84 years). The aetiology of constrictive pericarditis was idiopathic
(n=27, 60%), tuberculosis (n = 10, 22.2%), chronic renal failure (n= 4, 8.9%),
post-pericardiectomy (n=2, 4.4%), and neoplastic (n=2, 4.4%). Pericardial calcication was detected in 20% of patients on plain chest radiograph. The surgical
approach was median sternotomy in 43 patients and left anterolateral thoracotomy
in 2 patients [47].
Cardiopulmonary bypass was performed in 9 (20%) patients. The left phrenic
nerve was sacriced in 2 patients because of severe calcication and adhesion of the
nerve to the pericardium. Severe haemodynamic instability in 4 (8.9%) patients,
concomitant valve replacement in (6.7%), and severe iatrogenic intraoperative
bleeding in 2 (4.4%) were the primary reasons for use of cardiopulmonary bypass.
At a mean follow-up period of 40±18months (range 3–144months), one (2.3%)
patient was in NYHA Class III, while the rest were in Class I.The overall mortality
rate was 4.4%. These investigators concluded that pericardiectomy remains an
effective procedure in the treatment of constrictive pericarditis with low mortality
rates and excellent functional outcomes. Despite intensive vaccination and use of
anti-tubercular drugs, tuberculosis remained an important cause of constrictive pericarditis in Iran [47].
21.26 New York Medical Center, USA
Culliford AT and associates in 1979 reviewed their experience on 27 patients undergoing pericardiectomy at New York University Medical Centre over the past
13years. The mean age was 47years (range 10years to 64years) [22].
The duration of symptoms prior to denitive diagnosis and treatment varied
between 2months and 10years. The surgical approaches employed were median
sternotomy (n=13, 48%), left anterolateral thoracotomy (n=7, 26%), and bilateral
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21 Short- andLong-Term Results
thoracotomy (n=7, 26%). Twenty-two (81.5%) patients underwent radical pericardiectomy, and 5 (18.5%) patients underwent limited pericardial resection. Four
patients were placed on cardiopulmonary bypass; one patient underwent aortic
valve replacement for severe aortic regurgitation. The median sternotomy was associated with the shortest period of hospitalization—13.6 days. In the group of 4
patients undergoing pericardiectomy using cardiopulmonary bypass, the postoperative hospitalization averaged 25.8days. There was 1 (4%) postoperative death, and
no late deaths at a mean follow-up period of 4years (range 3months-12years).
Intraoperative pressure measurements demonstrated that radical pericardiectomy
immediately corrects haemodynamic abnormalities. Most patients underwent massive diuresis (7 to 16kg) within 2weeks with an uneventful recovery. These investigators concluded that two traditional concepts on pericardiectomy are erroneous:
i) pericardiectomy limited to the anterior and lateral surfaces of the ventricles is an
adequate operation, and ii) delayed recovery is due to myocardial ‘atrophy’ and not
to inadequate resection [22].
21.27 South-African Series
Reuter H and associates reported 30-day and one-year outcomes of large effusive
pericarditis on 233 consecutive patients between 1995 and 2001. 162 patients had
pericardial tuberculosis, including 118 (73%) with microbiological and/or histological evidence of tuberculosis and 44 (27%) diagnosed on clinical and supportive
laboratory data. They were treated with anti-tubercular drugs, and underwent echoguided pericardiocentesis and extended daily intermittent drainage via an indwelling pigtail catheter. Over the 6-year period, 2 patients developed brous constrictive
pericarditis after receiving antitubercular drug and adjuvant corticosteroid therapy [82].
The 30-day mortality (8%) was statistically higher for HIV positive patients than
for HIV negative patients (9.9% vs 6.2%, p=0.04). The one-year all-cause mortality was 17.3%. It was higher for HIV positive (22.2%) than for HIV negative patients
(12.3%, p = 0.03). They concluded that tubercular pericardial effusion responds
well on closed pericardiocentesis and a 6-month treatment of antitubercular
drugs [82].
References
1. Astudillo R, Ivert T. Late results after pericardiectomy for constrictive pericarditis via left
thoracotomy. Scand J Thorac Cardiovasc Surg. 1989;23:115–9.
2. Afzal A, Keohane M, Keeley E, Borzak C, Callender W, Iannuzzi M. Myocarditis and
pericarditis with tamponade associated with disseminated tuberculosis. Can J Cardiol.
2000;16:519–21.
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