Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO.
Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO.
J Cardiothorac Vasc Anesth. 2020 Apr;34(4):1099-1102. doi: 10.1053/j.jvca.2019.11.011. Epub 2019 Nov 19.
CONSTRICTIVE PERICARDITIS is characterized by progressive inflammation and fibrosis of the pericardium. It manifests with symptoms of heart failure. The only effective treatment is surgical pericardiectomy. The assessment and diagnosis of constrictive pericarditis with echocardiography is well described with spontaneous ventilation. However, there are limited data on constrictive pericarditis assessment with transesophageal echocardiography with positive pressure ventilation. Also, intraoperative hepatic venous Doppler flow mostly is used intraoperatively to assess the severity of tricuspid regurgitation by focusing on the flow reversal during systole. In this e-challenge, the authors focus on the hepatic vein Doppler tracing as a means to show improvement in diastolic function during positive pressure ventilation in a patient undergoing pericardiectomy. This case demonstrates a severely blunted diastolic flow pattern in the hepatic vein that is reversed after successful pericardiectomy. Also, it shows blunted flow during systole compared to diastole post-pericardiectomy, indicating high right atrial pressure.
缩窄性心包炎的特征为心包进行性炎症和纤维化。它表现为心力衰竭的症状。唯一有效的治疗方法是心脏心包切除术。超声心动图对缩窄性心包炎的评估和诊断在自主通气时描述得很好。然而，关于正压通气下经食管超声心动图评估缩窄性心包炎的数据有限。此外，术中肝静脉多普勒血流主要用于术中评估三尖瓣反流的严重程度，重点关注收缩期的血流反转。在这个电子挑战中，作者关注肝静脉多普勒轨迹，作为一种在接受心包切除术的患者中在正压通气期间显示舒张功能改善的方法。该病例展示了一例肝静脉舒张期血流模式严重钝挫，心包切除术后血流反转。此外，与心包切除术后的舒张期相比，收缩期血流也较钝，表明右心房压力高。
