Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Nepal.
Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Nepal.
Indian J Tuberc. 2021 Apr;68(2):174-178. doi: 10.1016/j.ijtb.2020.08.002. Epub 2020 Aug 8.
Tuberculosis remains an important cause of chronic constrictive pericarditis (CCP) in developing countries. It is a surgically treatable cause of diastolic heart failure. Without surgery, it is associated with high morbidity and mortality.
We conducted a retrospective observational study of clinical presentations and perioperative outcomes of pericardiectomy in all patients operated from July 2015 to December 2018 for tuberculous CCP.
A total 14 patients (mean age - 38 ± 13.3 years, 10 male), underwent pericardiectomy via median sternotomy without cardiopulmonary bypass. Eleven patients (79%) had completed treatment for pulmonary tuberculosis, and three (21%) were on anti-tubercular treatment at the time of referral for surgery. Ten patients (71%) had prior hospitalisation for cardiac failure. At the time of surgery, eight patients (57%) were in New York Heart Association (NYHA) class III-IV. The median duration of symptoms before surgical intervention was 15 months (range 11-24 months). Three patients (21%) had associated cardiac cirrhosis. Twelve patients (86%) underwent total pericardiectomy. Two patients (14%) underwent partial pericardiectomy. The mean operative time was 160 ± 33.8 minutes. The mean central venous press pressure before and after surgery were 28 ± 3.9 and 10 ± 2 mmHg respectively. The mean intensive care unit (ICU) and hospital stays were 4 ± 1.5 and 10 ± 2 days respectively. There was one (7%) 30-day mortality. There were two deaths (14%) due to non-cardiac causes at 10 and 16 months respectively. The remaining 11 patients (79%) are doing well (mean follow-up- 23 months), and are in NYHA class I.
Tuberculosis is the most common cause of CCP in our region. Pericardiectomy provides definitive treatment to alleviate symptoms resolution and improve survival.
结核病仍是发展中国家慢性缩窄性心包炎（CCP）的重要病因。它是舒张性心力衰竭的一种可手术治疗的病因。如果不进行手术，其发病率和死亡率都很高。
我们对 2015 年 7 月至 2018 年 12 月期间因结核性 CCP 接受心包切除术的所有患者的临床表现和围手术期结局进行了回顾性观察研究。
共有 14 名患者（平均年龄 38±13.3 岁，男性 10 名）接受了经胸骨正中切开术的心包切除术，未行体外循环。11 名患者（79%）已完成肺结核治疗，3 名患者（21%）在转至外科手术时正在接受抗结核治疗。10 名患者（71%）曾因心力衰竭住院。手术时，8 名患者（57%）处于纽约心脏协会（NYHA）III-IV 级。手术干预前症状持续时间中位数为 15 个月（范围 11-24 个月）。3 名患者（21%）合并心脏肝硬化。12 名患者（86%）行全心包切除术，2 名患者（14%）行部分心包切除术。平均手术时间为 160±33.8 分钟。手术前后中心静脉压分别为 28±3.9mmHg 和 10±2mmHg。平均重症监护病房（ICU）和住院时间分别为 4±1.5 天和 10±2 天。有 1 例（7%）发生 30 天死亡。有 2 例（14%）因非心脏原因分别在第 10 个月和第 16 个月死亡。其余 11 名患者（79%）情况良好（平均随访时间 23 个月），处于 NYHA I 级。
结核病是我们地区 CCP 的最常见病因。心包切除术可提供确定性治疗，缓解症状并提高生存率。
