Bluhm Cardiovascular Institute, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
J Am Coll Cardiol. 2024 Aug 6;84(6):561-580. doi: 10.1016/j.jacc.2024.05.048.
Remarkable advances have occurred in the understanding of the pathophysiology of pericardial diseases and the role of multimodality imaging in this field. Medical therapy and surgical options for pericardial diseases have also evolved substantially. Pericardiectomy is indicated for chronic or irreversible constrictive pericarditis, refractory recurrent pericarditis despite optimal medical therapy, or partial agenesis of the pericardium with a complication (eg, herniation). A multidisciplinary evaluation before pericardiectomy is essential for optimal patient outcomes. Overall, given the good outcomes reported, radical pericardiectomy on cardiopulmonary bypass, if feasible, is the preferred approach. Due to patient complexity, as well as the technical aspects of the surgery, pericardiectomy should be performed at high-volume centers that have the required expertise. The current review highlights the essential features of this multidisciplinary approach from diagnosis to recovery in patients undergoing pericardiectomy.
在心包疾病的病理生理学理解和多模态成像在该领域的作用方面已经取得了显著进展。心包疾病的药物治疗和手术选择也有了实质性的发展。心包切除术适用于慢性或不可逆转的缩窄性心包炎、尽管进行了最佳药物治疗仍反复发作的难治性心包炎，或部分心包缺如伴并发症（如疝）。心包切除术前进行多学科评估对于获得最佳患者结局至关重要。总的来说，鉴于报告的良好结果，如果可行，体外循环下心包切除术是首选方法。由于患者的复杂性以及手术的技术方面，心包切除术应在具有必要专业知识的高容量中心进行。目前的综述强调了在心包切除术患者从诊断到康复的多学科方法的基本特征。
