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Dammalapati PK, Kar SK, Mahapatra SS. Unmasking of severe mitral regurgitation after pericardiectomy. Indian J Thorac Cardiovasc Surg 2023; 39:402-406. [PMID: 37346447 PMCID: PMC10279624 DOI: 10.1007/s12055-023-01503-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 06/23/2023] Open
Abstract
Mitral valve prolapse in the young is the most common cause of mitral regurgitation (MR). Constrictive pericarditis (CP) is a chronic and end-stage manifestation of the inflammatory process of the pericardium. Apart from equalization of diastolic pressure of the chambers as well as increased ventricular interdependence, the thickened pericardial sheath in end-stage pericarditis fails to accommodate the intrathoracic venous return due to restricted cardiac chamber filling. Intracardiac valvular pathologies might co-exist in CP. This report presents a case in which effusive CP was associated with MR and highlights the pivotal role of intraoperative transesophageal echocardiography (TEE) in the decision-making of such co-existent lesions.
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Affiliation(s)
- Pavan Kumar Dammalapati
- Department of Cardio Thoracic Vascular Anaesthesiology, Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, 700020 India
| | - Sandeep Kumar Kar
- Department of Cardio Thoracic Vascular Anaesthesiology, Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, 700020 India
| | - Subhendu Sekhar Mahapatra
- Department of Cardio Thoracic Vascular Surgery, Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, India
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Abdallha M, Ahmed EO, Abdelatti M, Ageel O, Mokhtar M, Farag AMG. Mitral Valve Repair for Severe Mitral Regurgitation Masked by Constrictive Pericarditis Revealed After Pericardiectomy. J Cardiothorac Vasc Anesth 2020; 34:2456-2459. [PMID: 32417004 DOI: 10.1053/j.jvca.2020.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 11/11/2022]
Abstract
A case of severe mitral regurgitation (MR) that was masked by constrictive pericarditis and revealed after pericardiectomy is presented. Diagnosis was made intraoperatively with transesophageal echocardiography. Mitral valve repair was performed using a mitral annuloplasty ring. In some cases, worsening MR after pericardiectomy has been demonstrated to return to baseline with time. In the patient described, MR was severe with secondary ischemic pathology; therefore the decision was made to repair the mitral valve. Intraoperative transesophageal echocardiography played a major role in the decision making.
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Affiliation(s)
- Mohamed Abdallha
- Cardiac Anesthesia Department, King Abdullah Medical City in Holy Capital Makkah, Saudi Arabia
| | - Elnazeer O Ahmed
- Cardiac Surgery Department, King Abdullah Medical City in Holy Capital Makkah, Saudi Arabia
| | - Mohammed Abdelatti
- Cardiac Anesthesia Department, King Abdullah Medical City in Holy Capital Makkah, Saudi Arabia
| | - Omar Ageel
- Cardiac Anesthesia Department, King Abdullah Medical City in Holy Capital Makkah, Saudi Arabia
| | - Mohammed Mokhtar
- Cardiac Anesthesia Department, King Abdullah Medical City in Holy Capital Makkah, Saudi Arabia
| | - Ahmed M G Farag
- Cardiac Anesthesia Department, King Abdullah Medical City in Holy Capital Makkah, Saudi Arabia.
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He C, Suryani R, Hiew C, Cheng A, Zhang B. Mitral regurgitation following pericardiectomy for constrictive pericarditis. Asian Cardiovasc Thorac Ann 2016; 24:884-887. [DOI: 10.1177/0218492315593695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pericardiectomy is the only definitive treatment option for patients with constrictive pericarditis. We present the case of a 67-year-old man who developed new moderate to severe mitral regurgitation following phrenic nerve-to-phrenic nerve pericardiectomy for constrictive pericarditis. The severity of the regurgitation was followed up by serial echocardiography which showed improvement 19 days later and complete resolution at 9 months after surgery. Potential mechanisms explaining the evolution of this mitral valve dysfunction in the setting of pericardiectomy are postulated.
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Affiliation(s)
- Cheng He
- Department of Cardiothoracic Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Reny Suryani
- Department of Cardiology, Barwon Health, Geelong, Victoria, Australia
| | - Chin Hiew
- Department of Cardiology, Barwon Health, Geelong, Victoria, Australia
| | - Andrew Cheng
- Department of Cardiothoracic Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Bo Zhang
- Department of Cardiothoracic Surgery, Barwon Health, Geelong, Victoria, Australia
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Omoto T, Minami K, Varvaras D, Böthig D, Körfer R. Radical Pericardiectomy for Chronic Constrictive Pericarditis. Asian Cardiovasc Thorac Ann 2016. [DOI: 10.1177/021849230100900409] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A retrospective analysis was undertaken in 79 patients who underwent pericardiectomy for chronic constrictive pericarditis from January 1985 to February 1999. Most operations (77) were carried out with cardiopulmonary bypass, with subtotal pericardiectomy in 75 patients, and concomitant operations in 25. Postoperative complications occurred in 8 patients: cerebrovascular accident in 2, renal insufficiency in 5, bleeding in 2, low output syndrome in 4, and respiratory insufficiency in 2. The operative mortality was 5%; causes of death were cardiac-related in all cases. Actuarial survival at 1, 5, and 10 years was 89.9% ± 3.4%, 74.9% ± 5.7%, and 55.4% ± 13.5%, respectively. Regression analysis was performed using 53 clinical variables. Female gender, renal insufficiency, concomitant coronary artery bypass grafting, and preoperative right ventricular end-diastolic pressure > 20 mm Hg were found to be predictors of poor survival. At follow-up, improved functional status was noted in 88% of patients. Subtotal pericardiectomy can be performed on cardiopulmonary bypass with low mortality and good long-term survival.
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Affiliation(s)
- Tadashi Omoto
- Department of Thoracic and Cardiovascular Surgery Heart Center North-Rhine-Westphalia Ruhr-University of Bochum Bad Oeynhausen, Germany
| | - Kazutomo Minami
- Department of Thoracic and Cardiovascular Surgery Heart Center North-Rhine-Westphalia Ruhr-University of Bochum Bad Oeynhausen, Germany
| | - Dimitrios Varvaras
- Department of Thoracic and Cardiovascular Surgery Heart Center North-Rhine-Westphalia Ruhr-University of Bochum Bad Oeynhausen, Germany
| | - Dietmer Böthig
- Department of Thoracic and Cardiovascular Surgery Heart Center North-Rhine-Westphalia Ruhr-University of Bochum Bad Oeynhausen, Germany
| | - Reiner Körfer
- Department of Thoracic and Cardiovascular Surgery Heart Center North-Rhine-Westphalia Ruhr-University of Bochum Bad Oeynhausen, Germany
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Mahapatra RP, Kumar RV, Tella RD, Barik R, Krishna L, Malempati AR. Pericardiectomy for chronic constrictive pericarditis: risks factors and predictors of survival. Indian J Thorac Cardiovasc Surg 2014. [DOI: 10.1007/s12055-014-0308-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Taguchi S, Ishida O, Mori A, Suzuki R. Pericardiectomy for constrictive pericarditis with postoperative increase of tricuspid regurgitation. ACTA ACUST UNITED AC 2013. [DOI: 10.7243/2052-4358-1-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Nakamura T, Masai T, Yamauchi T, Higuchi T, Ito H, Toyoshima Y, Sawa Y. Successful surgical management for severe mitral regurgitation unmasked after pericardiectomy for chronic constrictive pericarditis. Ann Thorac Surg 2009; 86:1994-6. [PMID: 19022033 DOI: 10.1016/j.athoracsur.2008.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 04/09/2008] [Accepted: 05/05/2008] [Indexed: 01/12/2023]
Abstract
A 78-year-old cachectic woman who previously had repair of atrial septal defect was admitted to the hospital for congestive heart failure. Cardiac workup revealed chronic constrictive pericarditis; no evidence of coronary or valvular disease was found. She underwent corrective surgery for pericardiectomy. Intraoperative transesophageal echocardiography after pericardiectomy demonstrated acute development of severe mitral regurgitation, which was not preoperatively observed. She eventually required mitral valve replacement and tricuspid valve repair after conservative management failed. She recovered from the operation and was discharged. We believe that this is the first report of successful surgical management of mitral regurgitation that developed acutely after pericardiectomy.
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Affiliation(s)
- Teruya Nakamura
- Division of Cardiovascular Surgery, Sakurabashi-Watanabe Hospital, Osaka, Japan
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Bevilacqua S, Lazzeri C, Romagnoli S, Gelsomino S, Lorusso R, De Cicco G, Gensini GF. Unexpected severe tricuspid regurgitation after successful mitral valve repair. J Cardiothorac Vasc Anesth 2008; 23:251-2. [PMID: 18834774 DOI: 10.1053/j.jvca.2008.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Indexed: 11/11/2022]
Affiliation(s)
- Sergio Bevilacqua
- Department of Heart and Vessels, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
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Abstract
Constrictive pericarditis is an uncommon but treatable cause of heart failure that results from a variety of acute inflammatory processes. Corticosteroids appear to prevent the development of constriction in selected patients with active pericardial inflammation. Symptoms of right-sided heart failure usually predominate and can be adequately managed with diuretics. Complete surgical pericardiectomy remains the only definitive treatment. The mortality risk is markedly increased in patients with advanced symptoms, and surgery should be performed in earlier stages. The majority of patients (95% on average) will survive the surgery; complete relief of symptoms occurs in about 50% of survivors. Ten percent of patients will have persistent symptomatic heart failure (New York Heart Association functional class III or IV) and experience poor late outcomes, however, particularly when residual myocardial dysfunction coexists.
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Terada Y, Mitsui T, Yamada S. Mitral regurgitation after pericardiectomy for constrictive pericarditis. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 1999; 47:27-30. [PMID: 10077890 DOI: 10.1007/bf03217936] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
We report a case of constrictive pericarditis in which trace mitral valve regurgitation was detected preoperatively and temporarily worsened after a pericardiectomy was performed. The early postoperative data suggested that the increased mobility of the lateral wall, in conjunction with an increase in the left ventricular volume, might be one of the causes of the perioperative mitral valve dysfunction. The mitral valve function returned to the preoperative baseline thirteen months after the pericardiectomy.
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Affiliation(s)
- Y Terada
- Department of Cardiovascular Surgery, University of Tsukuba, Ibaraki, Japan
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