TITLE:
Surgical Treatment of Chronic Constrictive Pericarditis in a Developing Country
AUTHORS:
Kouassi Antonin Souaga, Eric Koutoua Katché, Yoboua Aimé Kirioua-Kamenan, Jean Calaire Degré, Kwadjau Anderson Amani, Gnamien Randolph Niava, Joseph Kouamé, Paul Yapo Yapo, Kouassi Flavien Kendja
KEYWORDS:
Constrictive Pericarditis, Subtotal Pericardectomy, Result
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.12 No.11,
November
25,
2022
ABSTRACT: Background: Chronic constrictive pericarditis is a rare but serious clinical entity
with a poor prognosis in the absence of surgical treatment. The purpose of this
study was to report on our experience of subtotal anterior pericardectomy and
analyze our surgical results. Results: We included 74 patients operated
on for chronic constrictive pericarditis in our institution during the period
from January 1985 to December 2020. There were 29 female and 45 male patients,
with an average age of 28 years (range: 8 - 64
years). 36.5% of patients were in NYHA class III or IV. Physical signs were
dominated by peripheral signs of right heart failure in 93.2% of cases. The
surgical procedure was a subtotal anterior
pericardectomy from the left to the right phrenic nerve, freeing the
heart chambers and the large vessels. The surgical results were marked by a
functional improvement in 82.4% of the cases. The postoperative complications
were marked by a low cardiac output in 8.1% of the cases, a atrial fibrillation
in 4.1% of the cases, a haemorrhage in 1.4% of the cases, a haemothorax in 2.7%
of the cases. Perioperative mortality was 5.4% patients. The causes of death were low cardiac output in 50% of cases,
hemorrhage in 25% of cases, and hepatocellular insufficiency in 25% of cases.
We observed a mortality of 2.9% after an average follow-up of 5.17 years ± 4.76 years. All other survivors were asymptomatic
and no re-intervention for recurrence was performed. Conclusions: Subtotal
anterior pericardectomy was the technique we used for the treatment of chronic
constrictive pericarditis. It allowed having
satisfactory surgical results with a functional improvement and an acceptable morbidity.