Ohmi M, Oda K, Ito T, Sadahiro M, Shoji Y, Tabayashi K
Department of Thoracic and Cardiovascular Surgery, Tohoku University School of Medicine, Sendai, Japan.
Kyobu Geka. 1995 Jul;48(7):526-31.
Between 1975 and 1994, we performed 20 pericardiectomies for 19 patients with constrictive pericarditis (CP) through a median sternotomy (13 cases), a left thoracotomy (2 cases), a median sternotomy combined with a left thoracotomy (4 cases) or a median sternotomy under ECC (1 case). One patient died from LOS at 1st POD due to myocardial failure. Pericardiectomy through a median sternotomy decreased RA pressure but PAW pressure did not decrease in some patients. On the contrary, pericardiectomy through either a left thoracotomy or a median sternotomy combined with a left thoracotomy decreased PAW pressure as well as RA pressure significantly. Responses to bicycle exercise demonstrated marked elevation of RA and PAW pressures even in a mild case of CP, so that the exercise testing seems to be useful for early detection of CP and evaluation of the operative results.
1975年至1994年间，我们通过正中胸骨切开术（13例）、左胸廓切开术（2例）、正中胸骨切开术联合左胸廓切开术（4例）或体外循环下正中胸骨切开术（1例），为19例缩窄性心包炎（CP）患者实施了20例心包切除术。1例患者在术后第1天因心肌衰竭死于住院期间。通过正中胸骨切开术进行心包切除术可降低右心房压力，但部分患者肺动脉楔压并未降低。相反，通过左胸廓切开术或正中胸骨切开术联合左胸廓切开术进行心包切除术可显著降低肺动脉楔压和右心房压力。即使在轻度CP病例中，自行车运动试验也显示右心房和肺动脉楔压明显升高，因此运动试验似乎有助于CP的早期检测和手术效果评估。
