Elsevier

American Heart Journal

Volume 118, Issue 6, December 1989, Pages 1292-1301
American Heart Journal

Constrictive pericarditis after cardiac surgery: Report of three cases and review of the literature

https://doi.org/10.1016/0002-8703(89)90021-5Get rights and content

Abstract

Constrictive pericarditis after cardiac surgery is a rare phenomenon occurring with an incidence of 0.2 % to 0.3 %. To date only 158 cases have been reported in the world literature. Symptoms include dyspnea (81 %), chest pain (34 %), and fatigue (29 %). Peripheral edema (90%) and an elevated jugular venous pressure (86%) were the most common abnormal signs found during physical examination. Chest x-ray and ECG abnormalities were not helpful in making the diagnosis, and abnormal echocardiographic findings were reported in less than half of the cases. Computerized tomography and magnetic resonance imaging scans of the heart were usually of great diagnostic benefit. Diastolic equalization of cardiac pressures remains the sine que non for diagnosis. Oral steroids have been reported to favorably alter the course early in the disease, but pericardial stripping remains the definitive form of therapy. Operative mortality rates vary from 5.5 % to 14.5 %.

References (51)

  • J.W. Kilman et al.

    The changing spectrum or pericardiectomy for chronic pericarditis: occult constrictive pericarditis

    J Thorac Cardiovasc Surg

    (1977)
  • J.M. Porter et al.

    Mesothelial fibronolysis

    J Thorac Cardiovasc Surg

    (1971)
  • W.J. Cliff et al.

    Postoperative pericardial adhesions: the role of mild serosal injury and spilled blood

    J Thorac Cardiovasc Surg

    (1973)
  • D.B. Effler

    Chronic constrictive pericarditis treated with pericardiectomy

    Am J Cardiol

    (1961)
  • W.J. Cliff

    Postoperative pericardial adhesions: the role of mild serosal injury and spilled blood

    J Thorac Cardiovasc Surg

    (1973)
  • J.N. Cunningham et al.

    Influence of primary closure of the pericardium after open-heart surgery on the frequency of tamponade, postcardiotomy syndrome and pulmonary complications

    J Thorac Cardiovasc Surg

    (1975)
  • J.S. Douglas et al.

    Late cardiac tamponade after open heart surgery: a problem of differential diagnosis

    Am J Cardiol

    (1975)
  • R.L. Soulen et al.

    Magnetic resonance imaging of constrictive pericardial disease

    Am J Cardiol

    (1985)
  • R. Shabetai et al.

    The hemodynamics of cardiac tamponade and constrictive pericarditis

    Am J Cardiol

    (1970)
  • E.W. Hancock

    On the elastic and rigid forms of constrictive pericarditis

    Am HEART J

    (1980)
  • A.T. Culliford et al.

    Do the surgical approach and degree of pericardial resection influence the outcome significantly?

    Ann Thorac Surg

    (1980)
  • W.A. Schiavone

    The changing etiology of constrictive pericarditis in a large referral center

    Am J Cardiol

    (1986)
  • M.A. Kukucka et al.

    Constrictive pericarditis as a complication of cardiac surgery: recognition of an entity

    Circulation

    (1979)
  • D.M. Killian et al.

    Constrictive pericarditis after cardiac surgery

    Circulation

    (1987)
  • M.V. Cohen et al.

    Constrictive pericarditis: early and late complications of cardiac surgery

    Am J Cardiol

    (1979)
  • Cited by (54)

    • Epicardial Ventricular Tachycardia Ablation. A Multicenter Safety Study

      2010, Journal of the American College of Cardiology
      Citation Excerpt :

      No case of constrictive pericarditis was noted after a mean follow-up period of almost 2 years. Whether the follow-up was too short to develop this complication is uncertain, but it would be unlikely that the risk for constrictive pericarditis after epicardial ablation exceeds the risk after cardiac surgery, for which it has been estimated to be 0.2% to 0.3% (17). Chest pain during the procedure is obviously an issue and requires powerful analgesia such as fentanyl or sufentanyl in the absence of general anesthesia.

    • Coronary constriction in constrictive pericarditis [6]

      2006, International Journal of Cardiology
    • Constrictive pericarditis

      2017, Constrictive Pericarditis and Cardiac Tamponade: Epidemiology, Causes and Management
    View all citing articles on Scopus
    View full text