Late Results after Pericardiectomy for Chronic Constrictive Pericarditis via Median Sternotomy Following with M-mode Echocardiography.

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  • 収縮性心膜炎における心膜剥皮術の方法と心臓超音波検査所見による遠隔期評価

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Our experience with 13 patients (mean age 52, range 35-71 years) undergoing pericardiectomy at Mitsui Memorial Hospital in the 13 years (from 1977 to 1990) has examined with clinical features and M-mode echocardiographic study. Preoperatively, the patients were either in N. Y. H. A. Functional Class III (11 cases), or Class IV (2 cases). Median sternotomy without using cardiopulmonary bypass was employed in all cases. The area of the right ventricle, atria, cavae, pulmonary veins and left ventricle where can be reached without cardiopulmonary bypass or other hemodynamic support were decorticated completely, and the posterior portion of the left ventricle were not decorticated partially. Intraoperative hemodynamic responses were observed between before and after pericardiectomy monitored by Swan-Ganz catheter; central venous pressure (CVP) were changed from 21.3±5.6 to 13.6±4.0cmH2O, pulmonary artery diastolic pressure (PADP) were changed from 19.8±5.5 to 11.3±6.6mmHg, cardiac index (CI) were changed 2.14±1.34 to 3.16±1.73l/min/m2. There were no early deaths and no late heart complicated deaths. There were 2 cases died, one for advanced gastric carcinoma and another for wide cerebral infarction whthin 3 years from pericardiectomy. M-mode echocardiographic study that were examined between preoperative and late postoperative periods (mean follow-up time 51 months) showed effective recovery in cardiac function; left ventricular end-diastolic volume index (LVEDVI) were from 34.3±12.1 to 39.5±14.5ml/m2, left ventricular end-systolic volume index (LVESVI) were from 17.2±7.8 to 13.1±6.7ml/m2, stroke index (SI) were from 17.1±7.3 to 26.6±12.5ml/m2, ejection fraction (EF) were from 45.1±19.2 to 61.2±22.5%, mean velocity of circumferential fiber shortening (mean Vcf) were from 0.80±0.35 to 1.13±0.53circ/sec. All the patients showed functional improvement; 9 are in N. Y. H. A. Functional Class I, and 4 are in Class II. These findings would be permitted this procedure with median sternotomy for chronic constrictive pericarditis as one of a safety and effective method conventionally.

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