TITLE:
Surgery for Pericardial Syndromes in Adults and Children: Clarification of Questionable Aspects
AUTHORS:
Ahmed Abdelrahman Elassal, Osman Osama Al-Radi, Husain Hamza Jabbad, Zaher Faisal Zaher, Mohamed Hasan Abdelsalam, Ahmed Mohamed Dohain, Gaser Abdelmohsen Abdelmohsen, Khalid Ebrahim Al-Ebrahim
KEYWORDS:
Surgery, Pericardial Syndromes, Adults, Children
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.10 No.11,
November
17,
2020
ABSTRACT: Background: The knowledge on
pericardial disease has increased but the European Society of Cardiology in the
last guidelines 2015 stated a section of perspective and unmet needs referring
to the surgical management as one of these needs. Here, we present an institutional
experience to contribute with other studies
in explanation of questionable aspects about their surgical management. Methods:
Among 127 cases (93 adults and 34 children) that were diagnosed as pericardial
syndrome, we retrospectively analyzed 45 cases (40 adults and 5 children)
operated for pericardial syndrome from May 2012 to June 2019. Echocardiogram
was the main preoperative diagnostic tool. Surgical approach was selected
according to each diagnosis. Postoperative clinical assessment, recurrence and
mortality rate were the main determinants of outcome. Results: Regarding pericardial effusions, the mean preoperative medical treatment period was 17.7 ± 21.9 days and pericardial window
through thoracotomy was the common approach (54.5%). In constrictive
pericarditis, infection was the main etiology (40%), mean preoperative medical
treatment period was 16 ± 8.8 days and complete pericardiectomy was the
surgical procedure for most cases. Trans-sternal drainage was the standard
approach for cardiac tamponade. No postoperative same admission recurrences
were reported and 11 (24.4%) mortalities were recorded, 7 (15.5%) cases of them were diagnosed as malignant effusions. Conclusion: Decision making and surgical approach
affect the outcome of surgery for pericardial syndromes. Children are
more responsive to medical treatment than adults are. Primary etiology and
patient’s condition are still the leading determinants of morbidity and
mortality.