Early Hemodynamic Changes After Pericardiectomy

Abstract

Patients and Methods:
Twentyfour patients undergoing pericardiectomy were studied in this series. History and Physical examination along with preliminary investigations were recorded. 2-D Echocardiography and Cardiac Catheterization were performed to confirm the diagnosis, as well as to exclude any other associated pathology. All these patients were on anti-failure and anti-tuberculosis treatment pre-operatively.

Results:
Pre-operatively all these patients had raised SVC and RA pressure (Table I). A drop in these pressures was recorded at two stages. First after the decortication of ventricles was completed and second; few minutes after the start of lonotropic support (Table I). Analysis of the change (Figure I) in pressure showed a significant drop due to lonotropic effect only.

Discussion:
Restricted Cardiac filling is the main factor responsible for congestive failure. Theoretically, it appears that after the excision of the constricting fibrous layer, a marked hemodynamic improvement will follow. This has led to the general belief that if the pericardiectomy is adequate, it will result in immediate drop in central venous pressure along with increase in blood pressure and urinary output (Shoemaker HB & Rosh J. 1960)2. Though all agree that this improvement continues for weeks till the atrophic myocardium gains its full strength (Wychullis AR et al. 1971).