Patil Devendra V, Sabnis Girish R, Phadke Milind S, Lanjewar Charan P, Mishra Prashant, Kulkarni Dwarkanath V, Agrawal Nandkishor B, Kerkar Prafulla G
Department of Cardiology, Seth G.S. Medical College and King Edward VII Memorial Hospital, Mumbai, India.
Department of Cardiology, Seth G.S. Medical College and King Edward VII Memorial Hospital, Mumbai, India.
Indian Heart J. 2016 May-Jun;68(3):316-24. doi: 10.1016/j.ihj.2015.09.027. Epub 2016 Jan 11.
Chronic constrictive pericarditis (CCP) is the end result of chronic inflammation of the pericardium. Developing countries continue to face a significant burden of CCP secondary to tuberculous pericarditis. Surgical pericardiectomy offers potential cure. However, there is paucity of echocardiography data in post-pericardiectomy patients vis-a-vis their clinical status. We studied the changes in multiple echocardiographic parameters in these patients before and after pericardiectomy.
Twenty-three patients (14 men, 9 women) who underwent pericardiectomy for CCP in the last 5 years (from January 2009 to December 2014) were subjected to detailed clinical and echocardiographic evaluation during the study period (between June 2013 and December 2014). Patients with residual symptoms of NYHA class II and below were considered as 'responders'. The data thus obtained were compared to the pre-operative parameters.
After pericardiectomy, the incidence of vena caval congestion decreased from 100% to 15% (p<0.001). There was significant reduction in the mean left atrial size from 39.33±10.52mm to 34.45±10.08mm (p<0.001) and also the ratio of left atrium to aortic annulus from 1.93 to 1.69 (p<0.001) among 'responders' to pericardiectomy. Septal bounce was observed to persist in 5 (25%) patients after pericardiectomy. There was significant respiratory variation of 39.23±15.11% in the mitral E velocity before pericardiectomy. After pericardiectomy, this variation reduced to 14.43±7.76% (p<0.001). There was also significant reduction in the respiratory variation in tricuspid E velocities from 31.33±18.81% to 17.35±16.26% (p<0.001). After pericardiectomy, the mean ratio of mitral annular velocities, medial e': lateral e', reduced from 1.08 to 0.87 (p<0.03). The phenomenon of 'annulus reversus' was found to persist in 6 'responders', thereby reflecting a 50% reduction in its incidence after pericardiectomy (p<0.001). The ratio of mitral E to medial e' (E/e') increased from 4.21±1.35 before pericardiectomy to 6.91±2.62 after pericardiectomy (p=0.001).
Among clinical responders to surgical pericardiectomy, echocardiographic assessment revealed a significant reduction in vena caval congestion, LA size, ratio of LA to aortic annulus, septal bounce, respiratory variation in mitral and tricuspid E velocities, mitral annular medial e' and the phenomenon of annulus reversus. Also, there was a significant rise in minimum tricuspid and mitral E velocities and the E/e' ratio.
慢性缩窄性心包炎（CCP）是心包慢性炎症的最终结果。发展中国家因结核性心包炎继发CCP仍面临着巨大负担。外科心包切除术提供了潜在的治愈方法。然而，相对于心包切除术后患者的临床状况，关于他们的超声心动图数据却很匮乏。我们研究了这些患者心包切除术前和术后多个超声心动图参数的变化。
在研究期间（2013年6月至2014年12月），对过去5年（2009年1月至2014年12月）因CCP接受心包切除术的23例患者（14例男性，9例女性）进行了详细的临床和超声心动图评估。纽约心脏协会（NYHA）心功能分级II级及以下且有残留症状的患者被视为“反应者”。将由此获得的数据与术前参数进行比较。
心包切除术后，腔静脉淤血的发生率从100%降至15%（p<0.001）。“反应者”心包切除术后，平均左心房大小从39.33±10.52mm显著减小至34.45±10.08mm（p<0.001），左心房与主动脉环的比值也从1.93降至1.69（p<0.001）。心包切除术后，观察到5例（25%）患者存在室间隔扑动。心包切除术前二尖瓣E峰速度的呼吸变化显著，为39.23±15.11%。心包切除术后，这种变化降至14.43±7.76%（p<0.001）。三尖瓣E峰速度的呼吸变化也从31.33±18.81%显著降至17.35±16.26%（p<0.001）。心包切除术后，二尖瓣环速度的平均比值，即内侧e'与外侧e'，从1.08降至0.87（p<（此处原文可能有误，推测应为p<0.03））。在6例“反应者”中发现“环反转”现象持续存在，从而表明心包切除术后其发生率降低了50%（p<0.001）。二尖瓣E峰与内侧e'的比值（E/e'）从心包切除术前的4.21±1.35增加至心包切除术后的6.91±2.62（p=0.001）。
在外科心包切除术的临床反应者中，超声心动图评估显示腔静脉淤血、左心房大小、左心房与主动脉环的比值、室间隔扑动、二尖瓣和三尖瓣E峰速度的呼吸变化、二尖瓣环内侧e'以及环反转现象均显著降低。此外，三尖瓣和二尖瓣E峰速度的最小值以及E/e'比值显著升高。
