Hemmati Pouya, Greason Kevin L, Schaff Hartzell V
Department of Cardiovascular Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
Department of Cardiovascular Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
Cardiol Clin. 2017 Nov;35(4):559-566. doi: 10.1016/j.ccl.2017.07.009.
Pericardiectomy is a potentially curative treatment for constrictive pericarditis. We use a median sternotomy and believe that adequate resection involves removal of the diaphragmatic pericardium and the anterior pericardium. Late outcomes depend on severity of right-sided heart failure preoperatively, the etiology of constrictive pericarditis, and adequate pericardial resection. Late results are excellent in patients with idiopathic disease or those with pericarditis secondary to prior cardiac operations. However, survival is reduced in those with radiation-induced constrictive pericarditis, primarily owing to additional secondary effects of radiation on cardiac valves, epicardial coronary arteries, and ventricular myocardium where fibrosis may cause associated restrictive cardiomyopathy.
心包切除术是治疗缩窄性心包炎的一种可能治愈的方法。我们采用正中胸骨切开术，并且认为充分的切除包括切除膈面心包和前部心包。远期疗效取决于术前右心衰竭的严重程度、缩窄性心包炎的病因以及心包的充分切除。对于特发性疾病患者或既往心脏手术后并发心包炎的患者，远期效果良好。然而，放射性缩窄性心包炎患者的生存率降低，主要是由于放疗对心脏瓣膜、心外膜冠状动脉和心室心肌的额外继发影响，纤维化可能导致相关的限制性心肌病。
