Indications, Results, and Pitfalls in the Surgery of Constrictive Pericarditis
Indications, Results, and Pitfalls in the Surgery of Constrictive Pericarditis
复制标题
缩窄性心包炎手术的适应症、结果和陷阱
作者：
R. Moosdorf
缩窄性心包炎是一种罕见的疾病，病因不明。在潜在疾病的发病和临床症状的出现之间可能有很长的延迟，这些临床症状是疲劳、腹部肿胀、周围水肿和呼吸困难。然而，如果临床表现明显，这些症状可能会迅速发展并严重影响患者。诊断是通过临床表现，超声心动图和/或MRI和右心导管。标准的治疗是扩大心包切除术，以恢复不受限制的流入和流出以及不受限制的双心室舒张功能。该手术的风险与两层心包层之间的致密粘连和严重的钙化（尤其是心外膜）有关。不完全去除会导致持续的舒张限制，而下层心肌的撕裂可能导致弥漫性和广泛出血，最终导致心肌功能障碍。此外，术后过程可能并发持续性低输出综合征或急性心室扩张。然而，在经验丰富的外科医生的早期手术干预提供了最好的预后。
Constrictive pericarditis is a rare disease with an often unclear etiology. There may be a long delay between the onset of the underlying disease and the onset of clinical symptoms, which are fatigue, abdominal swelling, peripheral edema and breathlessness. However, if clinically apparent, these symptoms may progress rapidly and severely disable the affected patient. Diagnosis is achieved by the clinical presentation, echocardiography and/or MRI and right heart catheterization.The standard therapy is an extended pericardiectomy to restore an unlimited inflow and outflow as well as an unrestricted diastolic function of both ventricles. The risks of this procedure are related to dense adhesions between the 2 pericardial layers and severe calcifications especially of the epicardium. Incomplete removal results in persistent diastolic restriction while lacerations of the underlying myocardium may lead to diffuse and extensive bleeding and finally to myocardial dysfunction. Also, the postoperative course may be complicated by persistent low output syndrome or acute ventricular dilatation. However, early surgical intervention in the hands of experienced surgeons offers the best prognosis.