Bashi V V, John S, Ravikumar E, Jairaj P S, Shyamsunder K, Krishnaswami S
Department of Thoracic and Cardiovascular Surgery, Christian Medical College and Hospital, Vellore, South India.
Thorax. 1988 Aug;43(8):637-41. doi: 10.1136/thx.43.8.637.
The medical records of 118 patients (86 male, 32 female, age 10-50 (mean 27) years) who underwent pericardiectomy for constrictive pericarditis at the Christian Medical College Hospital, Vellore, from 1954 to 1985 were reviewed. All had appreciable pericardial constriction. Preoperatively 97 of the 118 were in class III or IV of the New York Heart Association classification and 100 had peripheral oedema or ascites. Tuberculosis was proved as the cause in 72 patients. Pericardiectomy was accomplished through a standard anterolateral thoracotomy (107 cases), median sternotomy (3 cases), or bilateral thoracotomy (8 cases). Postoperatively an apparent low cardiac output state was seen in 34 patients, 12 of whom died. Hospital mortality in the last 12 years was 11%. Mortality was higher in NYHA class III and IV patients. The improved surgical results recently may be related to increased use of inotropic support and prolonged ventilation. At follow up there were 72 patients in whom functional capacity could be assessed; 63 were in class I or II. The poor results of pericardiectomy in some patients are likely to be related to advanced preoperative disability and early pericardiectomy is therefore recommended.
回顾了1954年至1985年期间在维洛尔基督教医学院医院因缩窄性心包炎接受心包切除术的118例患者（86例男性，32例女性，年龄10 - 50岁（平均27岁））的病历。所有患者均有明显的心包缩窄。术前，118例患者中有97例属于纽约心脏协会分级的III级或IV级，100例有外周水肿或腹水。72例患者被证实病因是结核病。心包切除术通过标准的前外侧开胸手术（107例）、正中胸骨切开术（3例）或双侧开胸手术（8例）完成。术后34例患者出现明显的心输出量降低状态，其中12例死亡。过去12年的医院死亡率为11%。纽约心脏协会III级和IV级患者的死亡率更高。近期手术结果的改善可能与更多使用正性肌力支持和延长通气时间有关。在随访中，有72例患者的功能能力可以评估；其中63例属于I级或II级。心包切除术在一些患者中效果不佳可能与术前严重功能障碍有关，因此建议早期进行心包切除术。
