Talwar Sachin, Nair Vinitha Viswambharan, Choudhary Shiv Kumar, Sreeniwas Vishnubhatla, Saxena Anita, Juneja Rajnish, Kothari Shyam Sunder, Airan Balram
Cardiothoracic Center and Department of Biostatistics,All India Institute of Medical Sciences,New Delhi,India.
Cardiol Young. 2014 Aug;24(4):616-22. doi: 10.1017/S1047951113000814. Epub 2013 Jul 10.
Between January, 2002 and December, 2011, 27 patients (19 boys) underwent pericardiectomy. The mean age was 9.3 ± 4.96 years (range 0.4 to 15 years) and the mean duration of symptoms was 16.9 ± 22.15 months. In all, 25 patients had dyspnoea; eight were in New York Heart Association (NYHA) class IV; six had bacterial pericarditis; and 18 were on anti-tuberculosis treatment, although only nine had records suggesting tuberculosis. There were nine patients who underwent pre-operative pigtail catheter drainage of pericardial fluid. Surgical procedures were complete pericardiectomy (n = 20), partial pericardiectomy (n = 6), and pleuropericardial window (n = 1).The mean pre-operative right atrial pressure was 20.4 ± 4.93 mmHg. There were six hospital deaths due to low cardiac output (n = 5) and arrhythmia (n = 1). The mean intensive care unit stay was 2.7 ± 1.2 days and mean post-operative stay was 9.9 days. The mean right atrial pressure dropped to 8.7 ± 1.15 mmHg. Adverse outcomes defined as death/prolonged intensive care unit stay, prolonged post-operative stay were not associated with sex, diagnosis of tuberculosis or pyopericardium, or the duration of symptoms or pre-operative right atrial pressure. Younger patients had prolonged intensive care unit stay (p = 0.03) but not increased mortality. Advanced NYHA class predicted death (p = 0.02). The mean follow-up was 23.1 ± 23.8 months. All except one survivor are in NYHA class I and off all cardiac medications. Despite adequate surgery, pericardiectomy in children is associated with a high mortality, which is related to delayed surgery and poor pre-operative general condition. No specific pre-operative variable other than worse pre-operative NYHA class is a predictor of survival. Therefore, early pericardiectomy should be undertaken in such patients.
2002年1月至2011年12月期间，27例患者（19名男孩）接受了心包切除术。平均年龄为9.3±4.96岁（范围0.4至15岁），症状平均持续时间为16.9±22.15个月。总共有25例患者出现呼吸困难；8例为纽约心脏协会（NYHA）IV级；6例患有细菌性心包炎；18例正在接受抗结核治疗，尽管只有9例有提示结核病的记录。有9例患者在术前进行了心包积液的猪尾导管引流。手术方式为完全心包切除术（n = 20）、部分心包切除术（n = 6）和胸膜心包开窗术（n = 1）。术前平均右心房压力为20.4±4.93 mmHg。有6例患者因低心排血量（n = 5）和心律失常（n = 1）在医院死亡。重症监护病房平均住院时间为2.7±1.2天，术后平均住院时间为9.9天。平均右心房压力降至8.7±1.15 mmHg。定义为死亡/延长重症监护病房住院时间、延长术后住院时间的不良结局与性别、结核病或脓性心包炎的诊断、症状持续时间或术前右心房压力无关。较年轻的患者重症监护病房住院时间延长（p = 0.03），但死亡率未增加。NYHA分级较高预测死亡（p = 0.02）。平均随访时间为23.1±23.8个月。除一名幸存者外，所有患者均为NYHA I级且停用了所有心脏药物。尽管手术充分，但儿童心包切除术的死亡率较高，这与手术延迟和术前一般状况较差有关。除术前NYHA分级较差外，没有其他特定的术前变量可预测生存。因此，此类患者应尽早进行心包切除术。
