We study on 3 children pyopericarditis on July 1996 at the Thoracic and Cardiovascular Surgery Department Cho Ray Hospital. All of patients come from Pediatric Hospital. Diagnostic: pyopericarditis with pus from pericardiocentesis. Operation: largely pericardiectomy. Result: all patients are in good condition when they are discharge.
Myocarditis ; Pericardiocentesis ; Pericardiectomy ; surgery ; therapeutics ; child

Harmonic Scalpel(Ethicon Endo-Surgery, Cincinnati, OH) has many advantages including no muscular stimulation, low heat, less smoke, easy hemostasis using ultrasound and good operation field. In patient with constrictive pericarditis, Harmonic Scalpel was beneficial during pericardiectomy.
Hemostasis ; Hot Temperature ; Humans ; Pericardiectomy* ; Pericarditis, Constrictive ; Smoke ; Ultrasonography

A clinical study was done on 16 cases of constrictive pericarditis admitted to National Medical Center, from january, 1970 to October, 1982, were reviewed, conclusion as follows: 1) The patients with constrictive pericarditis generally revealed clinical features of right heart failure but low incidence of its characteristic features. 2) Hemodynamic and echocardiographic examinations were much helpful in confirmation of clinical diagnosis. 3) pericardiectomy was highly succesful in achievement of clinical improvement.
Diagnosis ; Echocardiography ; Heart Failure ; Hemodynamics* ; Humans ; Incidence ; Pericardiectomy ; Pericarditis, Constrictive*

OBJECTIVETo observe the hemodynamic changes in patients undergoing pericardiectomy at different operational stages.

METHODSTotally 16 consecutive patients receiving radical pericardiectomy were enrolled in this observational study. Hemodynamic variables were monitored continuously by pulse-indicated continuous cardiac output(PiCCO)system. Totally,three sets of intraoperative hemodynamic parameters were obtained at three different stages of pericardiectomy.

RESULTSDuring the pericardiectomy,the cardiac index[CI,(1.9±0.6),(2.7±0.6),(3.0±0.5)L·min(-1)·m(-2);P<0.05]and stroke volume index[SI,(22.5±8.7),(29.9±8.5),(30.1±8.5)dyn·s·cm(-5)·m(2);P<0.05]showed significant improvement,whereas central venous pressure[CVP,(17.1±5.0),(13.3±3.9),(12.3±3.0)mmHg;P<0.05]decreased significantly. Global end-diastolic volume index[GEDVi,(533±156),(580±153),(559±144)ml·m(-2);P<0.05]increased and stroke volume variation[SVV,(15.6±6.1)%,(10.8±4.2)%,(9.4±5.4)%;P<0.05]decreased intra-operatively. The majority of the above-mentioned hemodynamic improvements occurred after the resection of pericardium over the left ventricular outflow tract(LVOT).

CONCLUSIONSPiCCO system can serve as a reliable,less invasive hemodynamic monitoring method during pericardiectomy. Resection of the pericardium over the LVOT is the most important step of the pericardiectomy.

We report a case of circulatory collapse and cardiac arrest immediately after the patient was turned from the lateral decubitus position to the supine position following left pneumonectomy. Closed-chest resuscitation with medical and fluid interventions were inadequate. Emergency chest showed the deviation of heart to the left side and blunted apex. Left ventricular rupture during resuscitation was found subsequent thoracotomy. This rupture and inadequacy of closed-chest resuscitation were felt to be associated with the operative pneumonectomy and pericardiotomy.
Cardiopulmonary Resuscitation* ; Emergencies ; Heart ; Heart Arrest ; Humans ; Pericardiectomy ; Pneumonectomy* ; Resuscitation ; Rupture* ; Shock ; Supine Position ; Thoracotomy ; Thorax

The purpose of this presentation is to demonstrate a good results of a second operation, the Waffle procedure, in a patient who did not improve following pericardiectomy. Incomplete parietal pericardiectomy, myocardial fiber atrophy, and unexpected restrictive cardiomyopathy can be considered when the patient's symptom does not improve after pericardiectomy is carried out. Constrictive epicarditis is always ruled out. In our case, the patient having constrictive pericarditis combined with pericardial effusion received a pericardiectomy. However, hemodynamics and symptoms of the patient following the operation did not improve. However, we experienced a good result following a second operation, the Waffle procedure.
Atrophy ; Cardiomyopathy, Restrictive ; Hemodynamics ; Humans ; Pericardial Effusion* ; Pericardiectomy ; Pericarditis ; Pericarditis, Constrictive ; Rabeprazole

We report aprimary malignant pericardial mesothelioma. Thirty-eight-year-old male patient complained of dyspnea and chest pain with left shoulder pain. At first, we thought it was because of tuberculous constrictive pericarditis and performed medical management for one and a half years. But, the above symptom recurred repeatedly; therefore we did pericardiectomy and diagnosed his case as malignant pericardial mesothelioma. Tumor was sticked to the myocardium and complete resection was impossible. He received postoperative chemoradiotherapy.
Chemoradiotherapy ; Chest Pain ; Dyspnea ; Humans ; Male ; Mesothelioma* ; Myocardium ; Pericardiectomy ; Pericarditis, Constrictive* ; Pericarditis, Tuberculous ; Pericardium ; Shoulder Pain

Cardiac mesotheliomas are rare. It is difficult to diagnose them at an early stage because the symptoms are nonspecific. Here we report two cases that had been initially diagnosed as constrictive pericarditis but later were definitively diagnosed, after pericardiectomy, as mesothelioma. The two patients complained of dyspnea that lasted 4 months and 10 years. Chest CT showed mild pericardial effusion and thickened pericardium, which was found enveloping the heart without any lumps. Median sternotomy showed that the overall pericardium was thickened by more than 10 mm. Pericardiectomy (phrenic nerve to phrenic nerve) was performed and post-operative histology confirmed malignant mesothelioma. In one patient the disease recurred near the pericardium post-operatively at 7 months and the patient died at 11 months. The other patient received chemotherapy and was still alive at post-operative month 16. Pericardial mesothelioma is an extremely rare disease exhibiting clinical signs similar to those of constrictive pericarditis, and should be diagnosed at an early stage of onset.
Dyspnea ; Heart ; Humans ; Mesothelioma ; Pericardial Effusion ; Pericardiectomy ; Pericarditis, Constrictive ; Pericardium ; Rare Diseases ; Sternotomy ; Thorax

Although it is a rare complication of cardiac surgery, constrictive pericarditis still remains a difficult problem that needs an appropriate treatment after cardiac surgery. We had two patients with constrictive pericarditis presenting with unexplained right heart failure early after cardiac surgery, and the diagnosis of constrictive pericarditis was made by a specific finding of septal bounce shown in echocardiographic study. On the postoperative 40th day and 31st day, they underwent pericardiectomy by a left limited anterolateral thoracotomy. For one to two weeks since pericardiectomy, the cardiac failure symptoms were gradually relieved. For patients without improvement of the constrictive symptom and sign even with conservative medical therapy for constrictive pericarditis developed early after cardiac surgery, pericardiectomy by a left limited anterolateral thoracotomy is considered as a useful therapeutic mode.
Heart Failure ; Humans ; Pericardiectomy ; Pericarditis, Constrictive ; Postoperative Complications ; Thoracic Surgery ; Thoracotomy

Constrictive pericarditis is a rare complication after coronary artery bypass grafting In most cases pericardiectomy is required as a definitive treatment. However, there are several types of constrictive pericarditis such as transient cardiac constriction. Some types of constrictive pericarditis can only be managed with medical therapy. We report a 72-year-old female patient who developed subacute transient constrictive pericarditis with persistent left pleural effusion as a result of postcardiac injury syndrome. The patient went through coronary bypass surgery that was successfully treated with postoperative steroid therapy.
Aged ; Constriction ; Coronary Artery Bypass ; Female ; Humans ; Pericardiectomy ; Pericarditis, Constrictive ; Pericardium ; Pleural Effusion