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Chapter 26
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Unresolved Problems inChronic
Constrictive Pericarditis
Despite the experience spanning over 300 years, the diagnosis of chronic noncalcic and calcic constrictive pericarditis and the individual predictive ranking of
available diagnostic modalities remains challenging. Unlike other diseases linked to
underdevelopment and inammation e.g. rheumatic heart disease, aortoaoritis, and
endomyocardial brosis which have shown decrease in prevalence with socioeconomic development, constrictive pericarditis has not shown a declining trend. The
aetiology of constrictive pericarditis also has changed during the past decades leading to diagnostic uncertainties. Understanding the pathophysiology of constrictive
pericarditis and integrating the results of multimodality imaging and invasive hemodynamic studies are the Rosetta stone in the differential diagnosis of constrictive
pericarditis and other diseases like tropical endomyocardial brosis, restrictive cardiomyopathy, cardiac amyloidosis, and Budd-Chiari syndrome. Newly developed
diagnostic techniques like speckle tracking echocardiography, tissue Doppler imaging, dual-source computed tomography, tagged cardiac magnetic resonance imaging are promising novel developments.
Despite the global prevalence of tuberculous pericarditis, limited evidence based
data are available to guide its management. The unresolved issues include the difculty in establishing a bacteriological, immunological or histologic diagnosis, the
role of pericardiocentesis or open drainage and tissue diagnosis, the utility of
adjunctive steroids especially in HIV positive individuals and the decision-making
on the timing of surgical intervention [14, 15, 17–19, 22, 24–26].
Secondly, published literature enunciates the clinical presentation and outcomes
of tuberculous pericarditis in the pre HIV era. It is indeed possible that inoculation
with HIV modies the clinical course and long-term outcome of tuberculous pericarditis [24, 26].
The precise aetiopathogenesis of recurrent pericarditis, its relationship with
autoimmune or autoinammatory diseases and a possible therapeutic role of interleukin- 1 antagonists remains debatable and is scantily investigated [21].
Ltd. 2023
U. K. Chowdhury, L. K. Sankhyan, Surgical Treatment of Chronic Constrictive
Pericarditis, https://doi.org/10.1007/978-981-99-5808-5_26
397© The Author(s), under exclusive license to Springer Nature Singapore Pte
398
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26 Unresolved Problems inChronic Constrictive Pericarditis
Despite the effectiveness of surgical therapy in the treatment of constrictive pericarditis, there are disparate opinions regarding the usefulness of corticosteroids in
the treatment of tuberculous pericardial effusion, the timing of operation, the issue
of an optimal surgical approach, extent of decortication, and the requirement of
cardiopulmonary bypass. The operative tactics and techniques applied to pericardial
excision do not as yet match the pleomorphic pathology and pathophysiology presented by individual patients.
Ongoing and future systemic studies, controlled clinical trials, registries and
updated guidelines from the American Heart Association, American College of
Cardiology, European Society of Cardiology and Japanese Cardiovascular Society
are warranted to conrm these results in longer controlled trials [1, 3, 4, 12, 16].
The medical literature is rife with examples of therapies that seemed likely to be
benecial, but were in fact either pointless or harmful. Although cardiopulmonary
bypass aids in the surgical dissection by emptying the ventricular cavities, thus
clearly dening the exact dissection plane, facilitates the management of inadvertent cardiac injury and ultraltrates some third space uids, its routine usage remains
debatable [5–11, 13, 20, 22, 23].
Acquiring the information that documents benets of routine use of cardiopulmonary bypass for performing pericardiectomy compared to non- use of bypass is
more difcult, yet it is badly needed. The Stanford group routinely used cardiopulmonary bypass in almost all patients undergoing pericardiectomy [8, 9]. It is noteworthy that majority of patients in the Stanford series were either postcardiac
surgical or postirradiation group. Although Omoto’s team also used cardiopulmonary bypass in the great majority of patients, concomitant intracardiac operations
for associated congenital and acquired heart diseases were required in one-third (25
out of 79) patients [20].
In the Cleveland study, cardiopulmonary bypass was used only in one instance
due to excessive perioperative bleeding [2]. In the AIIMS study, cardiopulmonary
bypass was used in seven out of 547 patients undergoing pericardiectomy because
of perforation of the inferior cavoatrial junction, and pulmonary trunk, causing massive intraoperative bleeding [5–7].
A possible drawback of routine utilization of cardiopulmonary bypass is potentially increased risk of perioperative bleeding and other bypass related complications. Thus, one place to begin would be to dene a large population of patients
undergoing pericardiectomy for constrictive pericarditis, and assign them to one of
the two categories, i.e. pericardiectomy with or without employment of extracorporeal circulation. The cardiopulmonary bypass category could then be compared to
the non-bypass category, to identify the more benecial option. Such information
would be welcome and noteworthy. Nothing in the literature even remotely addresses
the above-mentioned strategies to objectively decide between the surgical options.
The surgeon is left to make a clinical (subjective) decision between the two surgical
protocols.
To test the above mentioned surgical strategy properly, a multi-institutional, prospective randomized trial of cardiopulmonary bypass vs non-cardiopulmonary
bypass in pericardiectomy would be necessary; this could be the last refuge for
References
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399
those who cannot accept the conicting sporadic reports of bleeding complications
and prolonged hospitalization related to extracorporeal circulation. Furthermore,
the rarity and spectrum of patients with constrictive pericarditis would make such a
trial difcult.
References
1. Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, Brucato A, Gueret P,
Klingel K, Lionis C, Maisch B, Mayosi B, Pavie A, Ristic AD, Sabaté Tenas M, Seferovic P,
Swedberg K, Tomkowski W, ESC Scientic Document Group. ESC guidelines for the diagnosis and management of pericardial diseases: the task force for the diagnosis and management
of pericardial diseases of the European Society of Cardiology (ESC)endorsed by: the European
Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015;2015(36):2921–64.
2. Bertog SC, Thambidorai SK, Parakh K, Schoenhagen P, Ozduran V, Houghtaling PL, Lytle
BW, Blackstone EH, Lauer MS, Klein AL. Constrictive pericarditis: aetiology and causespecic survival after pericardiectomy. J Am Coll Cardiol. 2004;43:1445–52.
3. Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davis JL, Douglas
PS, Faxon DP, Gillam LD, Kimball TR, Kussmaul WG, Pearlman AS, Philbrick JT,
Rakowski H, Thys DM.ACC/AHA/ASE 2003 guideline update for the clinical application of
echocardiography- summary article: a report of the American College of Cardiology/American
Heart Association task force on Murray RD, Apperson-Hansen C, Stugaard MPractice guidelines (ACC/AHA/ASE Committee to update the 1997 guidelines for the clinical application of
echocardiography). J Am Coll Cardiol. 2003;42:954–70.
4. Cheitlin MD, Armstrong WF, Aurigemma GP, etal. ACC/AHA/ASE 2003 guideline update
for the clinical application of echocardiography: summary article: a report of the American
College of Cardiology/American Heart Association task force on practice guidelines (ACC/
AHA/ ASE Committee to update the 1997 guidelines for the clinical application of echocardiography). Circulation. 2003;108:1146–62.
5. Chowdhury UK, Kumari LS.Pericardiectomy for chronic constrictive pericarditis: where are
we after 100 years? World J Surg Surg Res. 2018;1:1027–30.
6. Chowdhury UK, Narang R, Malhotra P, Choudhury M, Choudhury A, Singh SP.Indications,
timing and techniques of radical pericardiectomy via modied left anterolateral thoracotomy
(UKC’s modication) and total pericardiectomy via median sternotomy (Holman and Willett)
without cardiopulmonary bypass. J Prac Cardiovasc Sci. 2016;2:17–27.
7. Chowdhury UK, Subramaniam G, Kumar AS, Airan B, Singh R, Talwar S, etal. Pericardiectomy
for constrictive pericarditis: clinical, echocardiographic and haemodynamic evaluation of two
surgical techniques. Ann Thorac Surg. 2006;81:522–30.
8. Copeland JG, Riley JE, Fuller J. Pericardiectomy for effusive constrictive pericarditis after
heart transplantation. J Heart Transplant. 1986;5:171–2.
9. Copeland JG, Stinson EB, Griepp RB, Shumway NE.Surgical treatment of chronic constrictive pericarditis using cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1975;69:236–8.
10. Culliford AT, Lipton M, Spencer FC. Operation for chronic constrictive pericarditis do the
surgical approach and degree of pericardial resection inuence the outcome signicantly? Ann
Thorac Surg. 1980;29:146–52.
11. Gopaldas RR, Dao TK, Caron NR, Markley JG.Predictors of in-hospital complications after
pericardiectomy: a nationwide outcomes study. J Thorac Cardiovasc Surg. 2013;145:1227–33.
12. Klein AL, Abbara S, Agler DA, etal. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease. J
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13. Ling LH, Oh JK, Breen JF, Schaff JV, Danielson GK, Mahoney DW, Seward JB, Tajik
AJ.Calcic constrictive pericarditis: is it still with us? Ann Intern Med. 2000;132:444–50.
14. Mayosi BM, Ntsekhe M, Volmink JA, Commerford PJ. Interventions for treating tuberculous pericarditis. Cochrane Database Syst Rev. 2002;4:CD000526. https://doi.
org/10.1002/14651858.CD000526.
15. Mayosi BM, Wiysonge CS, Ntsekhe M, Volmink JA, Gumedze F, etal. Clinical characteristics
and initial management of patients with tuberculous pericarditis in the HIV era: the investigation of the management of pericarditis in Africa (IMPI Africa) registry. BMC Infect Dis.
2006;6:2.
16. Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y, Tomkowski WZ, Thiene
G, Yacoub MH, Priori SG, Alonso Garcia MA.Guidelines on the diagnosis and management
of pericardial diseases executive summary: the task force on the diagnosis and management of
pericardial diseases of the European Society of Cardiology. Eur Heart J. 2004;25(7):587–610.
17. Ntsekhe M, Hakim J.Impact of human immunodeciency virus infection on cardiovascular
disease in Africa. Circulation. 2005;112(23):3602–7.
18. Ntsekhe M, Wiysonge C, Volmink JA, Commerford PJ, Mayosi BM.Adjuvant corticosteroids
for tuberculous pericarditis: promising, but not proven. Q J Med. 2003;96:593–9.
19. Ntsekhe M, Wiysonge CS, Gumedze F, Maartens G, Commerford PJ, Volmink JA, Mayosi
BM.HIV infection is associated with a lower incidence of constriction in presumed tuberculous pericarditis: a prospective observational study. PLoS One. 2008;3(6):e2253.
20. Omoto T, Minami K, Varvaras D, Böthig D, Körfer R.Radical pericardiectomy for chronic
constrictive pericarditis. Asian Cardiovasc Thorac Ann. 2001;9(4):286–90.
21. Picco P, Brisca G, Traverso F, Loy A, Gattorno M, Martini R.Successful treatment od idiopathic recurrent pericarditis in children with interleukin-1beta receptor antagonist (Anakinra).
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22. Tirilomis T, Unverdorben S, von der Emde J.Pericardectomy for chronic constrictive pericarditis: risks and outcome. Eur J Cardiothorac Surg. 1994;8:487–92.
23. Tokuda Y, Miyata H, Motomura N, Araki Y, Oshima H, et al. Outcome of pericardiectomy for constrictive pericarditis in Japan: a nationwide outcome study. Ann Thorac Surg.
2013;96:571–6.
24. Wiysonge CS, Ntsekhe M, Mayosi BM.Initial report of the initiative to investigate the optimal
management of tuberculous pericarditis in Africa. J Am Coll Cardiol. 2005;45:141A.
25. Wragg A, Strang JIG.Tuberculous pericarditis and HIV infection. Heart. 2000;84:127–8.
26. Zumla A, Malon P, Henderson J, Grange JM.Impact of HIV infection on tuberculosis. Postgrad
Med J. 2000;76:259–68.
26 Unresolved Problems inChronic Constrictive Pericarditis
Index
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A
Acquired heart diseases, 15, 326, 398
All India Institute of Medical Sciences
(pericardiectomy) series, 105,
114, 129, 219, 266, 360, 364, 365, 367
American College of Cardiology, 60, 398
American Heart Association, 60, 224, 398
Amyloidoisis- cardiac
atrial natriuretic peptide related
amyloidoisis, 152, 154
cardiac biomarkers, 155
cardiac magnetic resonance ndings, 155
cardiac transplantation, 156, 157
diphosphonate or pyrophosphate nuclear
imaging, 155
echocardiographic features, 154–155
endomyocardial biopsy, 155
familial mutant transthyretin amyloidoisis,
152, 153
gadolinium enhancement, 155
grannular or sparkling ventricular wall,
153–155, 161
modied Mayo staging, 156
primary AL amyloidoisis, 153
senile systemic amyloidoisis, 153
serologic testing, 155
serum amyloid A amyloidoisis, 152
tetramer stabilizers, 157
Annulus reversus, 48, 51, 55, 96, 98–100,
102, 367
Ascites precox, 45, 76, 81, 82, 149, 332
Atrial natriuretic peptide, 12, 45, 77, 81,
152, 154
B
Biopsy (skin), 161
Biopsy liver, 161, 162, 168
Bone nibbler, 270
Breast carcinoma, 37, 362
Budd-Chiari syndrome
angiographic ndings, 168
anticoagulation therapy, 169
computed tomography, 167
hepatic venography, 168
liver biopsy, 168
liver transplantation, 170
magnetic resonance imaging ndings, 167
myeloproliferative disease, 166, 168
percutaneous transluminal angioplasty, 169
portal vein obstruction, 166
primary Bud-Chiari syndrome, 166
secondary Budd-Chiari syndrome, 165
sonographic features, 167
spider-web pattern, 168
stenting, 169–171
thrombolysis, 169
transjugular intrahepatic portosystemic
shunting (TIPS), 170
C
Calcic constrictive pericarditis
bone cutter, 284–288, 291, 293, 394, 395
calcic pericardial patch/band, 202, 220,
232, 270, 291, 311, 322, 366
calcic spurs/spicules, 57, 119, 202, 222,
249, 270, 271, 281, 286, 322,
338, 366
Springer Nature Singapore Pte Ltd. 2023
U. K. Chowdhury, L. K. Sankhyan, Surgical Treatment of Chronic Constrictive
Pericarditis, https://doi.org/10.1007/978-981-99-5808-5
401© The Editor(s) (if applicable) and The Author(s), under exclusive license to
402
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Index
Calcic constrictive pericarditis (cont.)
cavitational ultrasonic surgical aspiration
system (CUSA), 249, 272, 286
diagnosis, 268–272
incidence, 265–266
pathogenesis, 266–268
total pericardiectomy-surgical steps,
247–254, 389–392
total pericardiectomy via median
sternotomy (Holman and Willett),
281–298, 393–396
total pericardiectomy-video
presentation, 389–396
Cardiac magnetic resonance imaging
hemodynamic studies, 151
imaging sequences, 114
multidetector computed tomography,
108, 109
radionuclide venography, 155
Cardiopulmonary bypass in pericardiectomy,
203, 217–224, 231–243, 247–263, 268,
270, 272, 281–298, 301, 309, 312, 313,
321–326, 355, 358, 359, 362, 363, 365,
366, 368–374, 381–383, 389–396, 398
Chinese series, 364
Christian Medical College Hospital Vellore
Series, 372
Chronic constrictive pericarditis
annular constrictive pericarditis, 47, 202,
270, 364–366
ascites precox, 45, 76, 81, 82, 149, 332
atrial natriuretic peptide, 12, 45, 77, 81,
152, 154
autonomic dysfunction, 77
calcic constrictive pericarditis, 83, 202,
222, 265–272, 281–298, 332–333,
338, 360–361, 365–367, 389–397
cardiac biomarkers, 61, 155
cardiac catheterization, 45, 58, 59, 71, 72,
81, 84, 127–129, 146, 200, 221,
224, 305
cardiac cirrhosis, 45, 76, 82, 356
cardiac magnetic resonance imaging, 2, 11,
58, 105, 108, 112–117, 121, 127,
145, 150, 155, 163, 221, 224, 268,
269, 343, 397
chest radiography, 45, 46, 81, 84, 89–93,
150, 269, 330
clinical challenges, 45–61, 81–82
computed tomography, 13, 24, 56, 58, 61,
92, 93, 108–127, 143, 145, 167,
200, 268, 269, 322, 335, 343, 356,
360, 397
denition, 29–30
diagnostic dilemma, 45–61, 81–82, 127
dip-and-plateau sign, 58, 71, 95
echocardiography, 45–47, 56, 69, 73, 84,
92–108, 143, 144, 154–155, 161,
164, 188, 200, 202, 221, 224, 268,
305, 330, 335, 338, 343, 356, 360,
367, 368, 397
effusive-constrictive pericarditis, 24, 29,
37, 82, 89, 201, 311, 332, 333, 338,
340–342, 363, 364, 369
hemodynamic features, 58–61
hemodynamics, 58, 61, 89–129, 205,
219–221, 234, 238, 241, 261, 289,
356, 358, 367, 387, 397
Hurrell’s contribution, 58, 70, 73, 128
idiopathic constrictive pericarditis,
265–266, 357, 360, 362, 363
imaging studies, 89–129, 155
Kussmaul’s sign, 23, 45, 71, 82, 129, 144,
158, 199
localized constrictive pericarditis, 29
M or W contour of Bloomeld, 82
non calcic constrictive pericarditis, 201,
222, 336
pathophysiology of, 69–77
post cardiac transplant constrictive
pericarditis, 143
post open heart surgery constrictive
pericarditis, 369
radionuclide studies, 155
recurrent constrictive pericarditis, 223,
231, 361, 365
square root sign, 58, 71–73, 128,
129, 161
unresolved problems, 397–399
ventricular interdependence, 59, 60, 70–76,
94, 126, 127, 205, 310, 324
Chronic liver disease, 29, 166
Cirrhosis of the liver, 45, 143, 169
Cleveland Clinic Foundation Series, 362–363
Congenital heart diseases, 15
D
Denitions of pericardiectomy
partial pericardiectomy, 187, 218
radical pericardiectomy, 30, 187–188,
217, 218
subtotal pericardiectomy, 368
total pericardiectomy, 30, 106, 187,
217, 218
Delayed enhancement imaging, 120
Dialysis pericarditis, 37
Dystrophic calcication, 110, 266
Index
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403
E
Echocardiography
three-dimensional echocardiography, 104
transesophageal echocardiography, 47, 93,
144, 302, 305
transthoracic echocardiography, 47, 93,
190, 305
two-dimensional echocardiography, 47,
55, 93, 188
Effusive-constrictive pericarditis
denition, 340–341
management, 341
surgical manoeuvers, 342
Emory university, Atlanta, Georgia series of
pericardiectomy, 369
Endomyocardial biopsy, 55, 59, 81–84, 151,
155, 162, 163, 200, 336
Endomyocardial brosis, 29, 45, 60, 77, 82,
84, 92, 127, 128, 143, 144, 146–151,
154, 159, 199, 397
Eosinophilic cardiomyopathy
angiographic studies, 151
cardiac lesions, 148–149
cardiac magnetic resonance ndings, 150
causations, 146–148
echocardiographic ndings, 147
electrocardiographic ndings, 83, 147, 158
endocardiectomy and valvular
reconstruction, 151
endomyocardial biopsy, 84, 151
epidemiology, 146
left ventricular endomyocardial
brosis, 149
right ventricular endomyocardial
brosis, 149
tropical endomyocardial brosis, 146–148
Epicardial peel of Harrington, 24, 188, 218,
248, 282, 285, 313, 382, 394
European Association of
Echocardiography, 144
European Society of Cardiology, 60, 224, 341,
360, 398
G
German series of pericardiectomy, 321, 357,
363, 368–371
H
Hemochromatosis
cardiac hemochromatosis, 164
cardiac magnetic resonance imaging, 164
cirrhosis of liver, 164
hepatocellular carcinoma, 164
iron chelating agents, 164
skin pigmentation, 164
Hemopericardium, 36
Highly active antiretroviral therapy
(HAART), 340
Histoplasmosis, 36, 37
Holman and Willett median sternotomy for
pericardiectomy
surgical steps, 247–254
video presentation, 381–383
I
Implantable cardioverter debrillator, 37, 156
Inferior caval venous size, 145
Interventricular septal motion, 94–95
Intra-aortic balloon counterpulsation (IABC)
in pericardiectomy, 190, 205, 206, 302,
304, 310, 313, 324–326, 367, 373
pediatric balloon catheters, 325
J
Japanese Adult Cardiovascular Surgery
Database, 223, 322, 357, 359
Japanese Cardiovascular Society, 224, 398
Japanese Ministry of Health and Welfare
(JMHW), 162
Johns Hopkins Medical Institutions, Maryland
Study of pericardiectomy, 369–371
K
Kussmaul’s sign, 23, 45, 71, 82, 129, 144,
158, 199
Kussmaul, W.G., 59, 72, 128
L
Lassa fever, 36
Legionella pneumonia, 36
Localized constrictive pericarditis, 29
Loefer’s disease, 148
Low cardiac output syndrome
denition and recognition, 190, 304–310
hemodynamic variables, 191
IKON, 302
mechanical circulatory support, 310
monitoring and diagnostics,
190–191, 304–305
myths and controversies, 301
positive pressure ventilation, 310
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Index
Low cardiac output syndrome (Cont.)
semi-invasive hemodynamic
monitoring, 191
therapeutic options, 306
thermodilution catheter, 302
tissue Doppler imaging, 188–189, 302
transesophageal echocardiographic
monitoring, 302, 305
transonic NaCl dilution, 190, 305
transpulmonary lithium dilution method
(LiDCO), 190, 305
transpulmonary pulse contour cardiac
output (PiCCO), 190, 305
transthoracic bioimpedance, 190, 305
unresolved issues and
controversies, 301–303
vasopressor therapy, 309–310
Vigileo Flow TracTM Device, 190–192,
306, 312
M
Mechanical circulatory support
axial ow bounce, 324
intra-aortic balloon counterpulsation,
310, 324–326
left atrial-aortic assist devices, 324
Median sternotomy for pericardiectomy, 105,
217, 247–254, 270, 281–298, 307, 312,
363–365, 367, 368, 371, 372,
381–383, 393–396
Modied left anterolateral thoracotomy
(UKC’S modication)
surgical steps, 389–392
video presentation, 385–387
Multimodality imaging studies, 55, 84,
224, 360
Myocardial atrophy, 58, 127, 269, 272,
303, 355
Myocardial factor, 272
Myocardial brosis, 94, 110, 202, 222, 267,
272, 357
Myocardial tagging with spatial
modulation, 120
N
Nocardia asteroids, 36
NSAID’s in pericarditis, 344
O
Oblique pericardial sinus, 6
Oblique vein of Marshall, 3
Occult constrictive pericarditis, 24, 29,
128, 344
Bush and associates, 24, 344
P
Pericardial calcication
amorphous calcication, 46, 89, 268
atrioventricular groove, 30, 46, 55, 57, 89,
90, 92, 93, 109, 110, 112, 117–119,
121, 123, 124, 187, 218, 266, 268,
271, 322–324
cocoon calcication, 46, 89, 203, 268, 270,
281, 311, 366
doppler echocardiography, 61, 94, 101,
147, 188, 221, 224, 302, 356
echocardiographic features, 103, 144
egg shell calcication, 89, 268
Mayo Clinic echocardiographic
criterions, 266
M-mode echocardiography, 46, 60
pericardial thickness, 2, 13, 14, 29, 30, 46,
47, 56, 58, 92, 93, 109, 110, 121,
144, 145, 161, 338
speckle tracking echocardiography, 24, 55,
94, 103–108, 143, 144, 147, 202,
221, 367, 368, 397
tissue doppler imaging, 48, 51, 55, 60,
92–96, 98–103, 106, 143, 188–189,
302, 367, 368, 397
transesophageal echocardiography, 47, 93,
144, 302, 305
transthoracic echocardiography, 47, 93,
190, 305
two-dimensional echocardiography,
47, 93, 188
Pericardial effusion
bacterial, fungal, 199, 343
dialysis, 37, 204, 205
infective/non-infective, 267, 329
non tubercular, 364
tubercular, 69, 200, 331, 335, 374
Pericardial knock, 23, 45, 83, 144, 147, 333
Pericardiectomy
decision-making, 217–224
extracorporeal circulation, 321, 358–359,
398, 399
history, 23–24
indications, 35, 202, 219–222, 270,
338, 342
long-term outcomes, 171, 219, 224,
356–357, 397
median sternotomy using cardiopulmonary
bypass, 203, 223, 368
Index
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405
median sternotomy without
cardiopulmonary bypass, 247–254,
281–298, 381–383, 393–396
modied left anterolateral thoracotomy
(UKC’S modication), 221,
231–243, 255–263, 313, 322, 366,
385–387, 389–392
peri operative mortality, 170, 189,
220, 221, 223, 232, 272, 307,
311, 355–358, 362–364,
366, 368–372
post operative low cardiac output
syndrome, 355
radical pericardiectomy, 24, 30, 105, 187,
188, 202, 217, 218, 231–243,
255–263, 312, 313, 330, 358, 360,
362, 366, 374
reoperation, 219, 223, 232, 322, 359, 361
surgical approach(es), 56, 217–224,
231–243, 268, 269, 301, 305,
310–313, 358–359, 369, 373, 398
timing, 217–224, 310–313
total pericardiectomy without
cardiopulmonary bypass, 247–254,
281–298, 381–383,
385–387, 389–396
unresolved issues, 301–303
Pericarditis
autoimmune, 343, 344, 397
drug induced, 338–340
neoplastic, 36, 343, 345
post cardiac transplantation, 143
post irradiation, 223, 265, 356–358, 362,
369, 370
post surgery, 30, 356–358, 362–364
Pericardium
anatomy, 1–15
applied anatomy, 1–15
cardiac computed tomography, 2, 13
cardiac magnetic resonance imaging, 2,
11, 13, 14
brous pericardium, 1–3
histology, 1–15
imaging techniques, 13–14
innervation, 7–8
lymphatic drainage, 7–8
pericardial sinuses and recesses, 4,
6, 13–14
physiology, 1–15
serous pericardium, 2–4, 8
ultrastructural features, 8–11
vascular supply, 7–8
Phase contrast CMR, 14
Post caval recess (PCR), 4, 6–7
Preaortic recess, 14
Pulmonary embolism, 45, 143
Pulmonary hypertension, 45, 47, 60, 149, 150
Pulmonary thromboembolism, 47
Pulmonary venous recesses, 4, 6, 7
Pulsus paradoxus, 23, 45, 82, 129, 147, 199
Purulent/bacterial pericarditis
aetiology, 329–330
denition, 329
incidence, 329–330
management, 330
pathophysiology, 329–330
R
Relapsing/recurrent pericarditis
core trial, 343, 344
Mayo clinic recommendation, 344
treatment, 343, 344
Reoperations following pericardiectomy, 361
Restrictive cardiomyopathy
echocardiographic features, 84, 92, 94,
103, 143, 144, 147, 161, 202
electrocardiographic features, 83, 144,
158–161, 199
electrophoresis, 160
endomyocardial biopsy, 82–84, 151, 162
hemodynamics, 58, 161
renal biopsy, 162
Retro-aortic recess, 14
Right ventricular failure, 45, 82, 199, 206
Ring like calcication, 265
S
Salmonella infections, 36, 340
Sarcoidosis
cardiac magnetic resonance in
sarcoidosis, 163
cardiac positron emission tomography
imaging, 163
FDG imaging, 163
heart rhythm society, 162
holter monitoring, 163
implantable cardiac debrillators, 163
Japanese Society of Health and Welfare
Criteria, 162
medical treatment, 163
positron emission tomography CT, 163
Scout images, 117
Sellors and associates, 218
Septal shudder, 95, 144
406
https://t.me/medicina_free
Index
Society of Thoracic surgeons (STS), USA,
xxviii, 60
South African series (pericardiectomy), 374
Spanish series (pericardiectomy), 364
Stanford series (pericardiectomy), 223, 321,
341, 363, 398
Starling’s law/phenomenon, 204, 218
Steady State Free Precession Gradient Echo
(SSFP), 14, 122
Strain reversus, 94
Stroke volume variation (SVV), 191, 192, 307
Subxiphoid pericardiostomy, 202, 224
Superior aortic recess, 5, 7
SVV, see Stroke volume variation
Swedish series (pericardiectomy), 371–372
Systolic area index, 59, 60, 76, 128
T
T1 and T2 weighted images, 120, 122
TDI, see Tissue Doppler imaging
Tehran, Iran series (pericardiectomy), 373
Tissue Doppler imaging (TDI), 48, 51, 55, 60,
92–96, 98–103, 106, 143, 188–189,
302, 305, 367, 368, 397
Total pericardiectomy
surgical steps, 247–254, 389–392
video presentation, 381–383,
385–387, 389–396
Transient constrictive pericarditis, 29
Trans mitral Doppler inow, 55, 161, 188
Trans tricuspid Doppler inow, 71, 95, 188
Transverse pericardial sinus, 6, 14
Tricuspid stenosis, 45, 82, 199
Triple Inversion fast Spin-echo, 120
Tropical endomyocardial brosis, 45, 84, 127,
143, 146–148, 199, 397
Tubercular pericarditis, 35–36, 69, 81, 201,
266, 268, 269, 331, 336, 342, 360
Tuberculous pericardial effusion
anti tubercular drugs, 336, 338
biochemical methods, 336
concomitant HIV, 339–340
corticosteroids, 336, 338, 339
diagnostic criteria, 334–336
GeneXpert, 334, 338
pathogenesis, 331–332, 342
polymerase chain reaction, 334
treatment, 335, 336
Turkish series (pericardiectomy), 372–373
U
UKC’S modication (modied left
anterolateral thoracotomy)
anatomical basis, 231
surgical maneuvers/steps, 233, 389–392
technical details, 231–243
video presentation, 385–387
Unexplained heart failures, 29
US nationwide outcomes study
(pericardiectomy), 370
V
Vaitkus, P.T., 59, 72, 128
Valvular heart diseases, 47, 59, 82, 369
Velocity-encoded CMR, 14, 121–127
Ventricular interdependence, 59, 60, 70–76,
94, 122, 126, 129, 205, 310, 324
Video presentations for pericardiectomy,
381–383, 385–387, 389–396
Vogelpoel- Beck sign, 45–46
W
Wagner’s granulomatosis, 37
Whipple’s disease, 36, 37
WHO guidelines, 201, 338
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