Taner İYİGÜN, Barış TİMUR, Mugisha KYARUZİ, Veysel KUTAY

Konstriktif Perikarditin Cerrahi Tedavisi: Tek Merkezli Bir Deneyim

Giriş: Konstriktif perikardit (KP) nadir ve potansiyel olarak ölümcül bir hastalıktır. Sağ kalp yetmezliğinin önemli nedenlerinden biridir ve acil müdahale gerektirir. Bu çalışmanın amacı, hastane merkezimizde KP nedeniyle ameliyat edilen hastaların kısa ve orta dönem sonuçlarını araştırmaktır. Hastalar ve Yöntem: Merkezimizde KP nedeniyle perikardiyektomi uygulanan 27 hastanın verileri değerlendirildi. Klinik bulgular, görüntüleme modaliteleri, cerrahi teknik ve takip sonuçları retrospektif olarak değerlendirildi. Bulgular: Hastalarımızın yaş ortalaması 49.78 idi. Hastalarımızın en sık görülen semptomu dispne idi. Fiziksel muayene sırasında periferik ödem en sık görülen işaretti. Ortalama perikardiyum kalınlığı 3.4 mm ile 6.6 mm arasında değişmekteydi. Toplam 15 (%55.6) hastada perikardiyektomi, 12 (%44.4) hastada parsiyel perikardiyektomi uygulandı. Eşlik eden kardiyak cerrahi ile perikardiyektomi 5 (%18.5) hastada perfüze edildi. Maalesef postoperatif mortalite 4 (%14.8) hastada meydana geldi. Sonuç: Perikardın cerrahi olarak çıkarılması, bazı serilerde bildirilen yüksek mortalite oranlarına rağmen KP'li hastalarda tercih edilmesi gereken bir tedavi yöntemidir.

Anahtar Kelimeler:

Konstriktif perikardit, perikardiyektomi, mortalite

Surgical Treatment of Constrictive Pericarditis: a Single-Center Experience

Introduction: Constrictive pericarditis (CP) is a rare and potentially lethal disease. It is one of the important reasons of the right-sided heart failure, and it requires immediate intervention. The aim of this study was to investigate the short-term and mid-term results in patients who were operated for CP in our hospital center. Patients and Methods: We evaluated data of 27 patients who underwent pericardiectomy due to CP in our center. Clinical findings, results of imaging modalities, the surgical technique, and the follow-up were retrospectively evaluated. Results: The mean age of our patients was 49.78 years. The most common symptom was dyspnea. Peripheral edema was the most common sign during the physical examination. The mean pericardium thickness ranged between 3.4 mm and 6.6 mm in diameter. Total pericardiectomy was performed in 15 patients (55.6%), while partial pericardiectomy was performed in 12 patients (44.4%). Pericardiectomy with concomitant cardiac surgery was performed in 5 patients (18.5%). Unfortunately, postoperative mortality occurred in 4 patients (14.8%). Conclusion: Surgical removal of pericardium is a treatment modality that should be preferred in patients with CP, despite high mortality rates reported in some series.

Keywords:

Constrictive pericarditis, pericardiectomy, mortality,

PDF

___

1. Somerville W. Constrictive pericarditis.With special reference to the change in natural history brought about by surgical intervention. Circulation 1968;38:102-10.
2. Lower R. Treatment of Heart [in Latin]. London: Allestry, 1669.
3. Maisch B, Seferovic PM, Ristic AD, Erbel R, Rienmuller R, Adler Y, et al. 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;25:587-610.
4. Tokuta Y, Miyata H, Motomura N, Araki Y, Oshima H, Usui A, et al. Outcome of pericardiectomy for constrictive pericarditis in Japan: a nationwide outcome study. Ann Thorac Surg 2013;96:571-6.
5. Mayosi BM, Ntsekhe M, Bosch J, Pandie S, Jung H, Gumedze F, et al. Prednisolone and Mycobacterium indicus pranii in tuberculous pericarditis. N Engl J Med 2014;371:1121-30.
6. Tse G, Ali A, Alpendurada D, Prasad S, Raphael CE, Vassiliou V. Tuberculosis constrictive pericarditis. Res Cardiovasc Med 2015;4:e29614.
7. Nachum E, Sternik L, Kassif Y, Raanani E, Hay I, Shalabi A, et al. Surgical pericardiectomy for Constrictive pericarditis: A single tertiary center experience. Thorac Cardiovasc Surg 2018.
8. Bertog SC, Thambidorai SK, Parakh K, Schoenhagen P, Ozduran V, Houghtaling PL, et al. Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy. J Am Coll Cardiol 2004;43:1445-52.
9. Biçer M, Özdemir B, Kan I, Yüksel A, Tok M, Şenkaya I. Long-term outcomes of pericardiectomy for constrictive pericarditis. J Cardiothorac Surg 2015;10:177.
10. Busch C, Penov K, Amorim P, Garbade J, Davierwala P, Schuler GC, et al. Risk factors for mortality after pericardiectomy for chronic constrictive pericarditis in a large-single-centre cohort. Eur J Cardiothorac Surg 2015;48:e110-e6.
11. Bozbuga N, Erentug V, Eren E, Erdogan HB, Kirali K, Antal A, et al. Pericardiectomy for chronic constrictive tuberculous pericarditis: risks and predictors of survival. Tex Heart Inst J 2003;30:180-5.
12. Chowdhury UK, Subramaniam GK, Kumar AS, Airan B, Singh R, Talwar S, et al. Pericardiectomy for constrictive pericarditis: a clinical, echocardiographic, and hemodynamic evaluation of two surgical techniques. Ann Thorac Surg 2006;81:522-9.
13. 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.
14. Szabo G, Schmack B, Bulut C, Soos P, Weymann A, Stadtfeld S, et al. Constrictive pericarditis: risks, aetiologies and outcomes after total pericardiectomy: 24 years of experience. Eur J Cardiothoracic Surg 2013;44:1023-8.
15. Depboylu BC, Mootoosamy P, Vistarini N, Testuz A, El-Hamamsy I, Cikirikcioglu M. Surgical treatment of constrictive pericarditis. Tex Heart Inst J 2017;44:101-6.

ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi