Question:
Please
advise on what caution needs to be taken after a Pericardiectomy and
why.
Any other
useful information will be appreciated to.
Thank
you your assistance is appreciated
Answer:
It is
important to keep the incision areas clean and dry.
Symptomatic
relief and normalization of cardiac pressures may take several months
after pericardiectomy.
Longer-term
mortality rates after pericardiectomy exceed those of age-matched
populations.
The majority
of patients demonstrate a symptomatic improvement after surgery, but
up to 25% remain symptomatic.
Persisting
heart failure symptoms may necessitate continued diuretic therapy.
Left ventricular systolic dysfunction may occur after pericardial
stripping mainly due to myocardial fibrosis; this should be treated
with ACE inhibitor and beta-blocker therapy in the usual fashion.
Survival
after pericardiectomy is greatly dependent on patient age.
A review
of the few reports in literature about repeat operations for recurrent
pericardial constriction, reveals that all of the reported cases were
as a result of partial pericardiectomy with residual pericardium in
the posterior surface of the heart.
Diastolic
filling characteristics remain abnormal in a substantial number of
patients with constrictive pericarditis after pericardiectomy. These
abnormalities may resolve gradually but can persist.
Diastolic
filling abnormalities after pericardiectomy correlate well with clinical
symptoms and tend to occur in patients who have had symptoms longer
preoperatively.
Complete
pericardiectomy using a right anterolateral thoracotomy can be performed
safely and can lead to long-term survival and good functional results.
Long-term
survival after pericardiectomy for constrictive pericarditis differs
significantly based on disease etiology.
