Ni Y, von Segesser L K, Turina M
Clinic for Cardiovascular Surgery, University Hospital, Zürich, Switzerland.
Ann Thorac Surg. 1990 Mar;49(3):445-8. doi: 10.1016/0003-4975(90)90252-2.
Two patients underwent pericardiectomy for postirradiation constrictive pericarditis. Both had received radiotherapy (more than 6,000 rads) for treatment of Hodgkin's disease 17 (patient 2) and 20 years (patient 1) earlier. At the time of operation, the patients were in New York Heart Association functional class III-IV or IV. Preoperative catheterization showed the following pressures for patients 1 and 2, respectively: right atrial, 30 and 14 mm Hg; right ventricular end-diastolic, 28 and 14 mm Hg; wedge, 29 and 13 mm Hg; and left ventricular end-diastolic, 27 and 14 mm Hg. Complete epicardiectomy and pericardiectomy was attempted in both patients. However, hospital mortality was 100%; patient 1 died of multiorgan failure after six days, and patient 2 died of biventricular failure after 3 months. A review of the literature revealed 44 cases of pericardiectomy for postirradiation constrictive pericarditis and a late survival rate of less than 50%. The poor results in these patients compared with patients having pericardiectomy for other reasons seem to be due mainly to the various kinds of radiation-induced damage to the heart as a whole, including untimely coronary artery disease, myocardial fibrosis, atrioventricular conduction disturbances, and valve dysfunction, with the result that complete relief by epicardiectomy and pericardiectomy may not be technically feasible.
两名患者因放疗后缩窄性心包炎接受了心包切除术。两人均曾在17年前（患者2）和20年前（患者1）因霍奇金病接受过放疗（超过6000拉德）。手术时，患者处于纽约心脏协会心功能分级III - IV级或IV级。术前心导管检查显示患者1和患者2的压力分别如下：右心房，30和14毫米汞柱；右心室舒张末期，28和14毫米汞柱；楔压，29和13毫米汞柱；左心室舒张末期，27和14毫米汞柱。两名患者均尝试进行了完全的心外膜切除和心包切除术。然而，医院死亡率为100%；患者1在术后六天死于多器官功能衰竭，患者2在术后3个月死于双心室衰竭。文献回顾显示有44例因放疗后缩窄性心包炎接受心包切除术的病例，晚期生存率低于50%。与因其他原因接受心包切除术的患者相比，这些患者的预后较差，这似乎主要归因于放疗对整个心脏造成的各种损害，包括过早出现的冠状动脉疾病、心肌纤维化、房室传导障碍和瓣膜功能障碍，结果是通过心外膜切除和心包切除术实现完全缓解在技术上可能不可行。
