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

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*

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

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.

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

Constrictive pericarditis represents a rare cause of protein-losing enteropathy in children. Reported is an 11-year-old girl with protein-losing enteropathy (PLE) as the principal manifestations of constrictive pericarditis. After total pericardiectomy, symptoms and signs of PLE disappeared. Doppler echocardiography including tissue Doppler imaging is a useful noninvasive initial diagnostic tool for differential diagnosis of diastolic heart failure.
Child ; Diagnosis, Differential ; Echocardiography, Doppler ; Female ; Heart Failure, Diastolic ; Humans ; Pericardiectomy ; Pericarditis, Constrictive* ; Protein-Losing Enteropathies*

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

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

BACKGROUND: There are several ways to treat for recurrent pericardial effussion and cardiac tamponade due to malignancy. They are repeated pericardiocentesis, pericardial instillation of sclerosing and chemotherapeutic agents, surgical creation of a pericardial window and transthoracic pericardiectomy. Surgical techniques are usually effective but bear a significant morbidity and mortality especially in chronic debilitating cancer patients. So percutaneous balloon pericardial window as an alternative to surgery in these patients. METHODS: After pericardiocentesis was performed, a 0.035 inch J-tip guidewire was advanced into the pericardial space. And a pigtail catheter was advanced over the wire. A moderate amount of pericardial fluid were removed. A nd then the pigtail catheter was withdrawn and 8F sheath was inserted. A20mm diameter, 4cm long(Single balloon method) or two 10mm diameter, 4cm long balloon dilating catheter(Double balloon medium) was advanced over the wire to straddle the parietal pericardial border though the sheath. Several inflations of the balloon with a solution containing 50% radiographic contrast medium were performed until disappearance of the balloon waist. After balloon dilation, contrast medium from the pericardial space to subcutaneous tisse suggesting successful PBPWF. Single ballon method was employed in 4 patients and Dould balloon method in 2 patients. RESULT: We performed percutaneous balloon pericardial window formation in 6 patiemts with malignant pericardial effusion. We did percutaneous balloon pericardial window formation successfully in 5 patients and failed due to adhesion of parietal pericardium in 1 patient. One patient developed recurrent pericardial effusion with tamponade at a mean follow-up of 11.49.6 months(1.5-26 months). Conclusion: These results suggest that PBPWF is an alternative method less invasive than subxiphoid surgical windowing, espesially in critically ill patients with recurrent malignant pericardial effussion. It carries less risks and has more constant effect than repeated pericardiocentesis.
Cardiac Tamponade ; Catheters ; Critical Illness ; Follow-Up Studies ; Humans ; Mortality ; Pericardial Effusion* ; Pericardiectomy ; Pericardiocentesis ; Pericardium ; Rabeprazole