Pakistan Journal of Medical Sciences

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ISSN 1681-715X

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ORIGINAL ARTICLE

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Volume 26

October - December 2010

Number  4


 

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Management of constrictive pericarditis:
A comparative study between median
sternotomy and left thoracotomy

Hasan Ekim 1, Halil Basel 2, Dolunay Odabasi 3, Mustafa Tuncer 4

ABSTRACT

Objective: Constrictive pericarditis (CP) requires pericardiectomy but the choice of surgical approach remains controversial. Hence we have reviewed our experience of pericardiectomy carried out for CP and compared the results of pericardiectomy performed by median sternotomy versus left thoracotomy with regard to functional outcomes.

Methodology: The study group consisted of 33 patients with CP who underwent pericardiectomy from May 1999 to January 2010 at our institution. There were 22 female and 11 male patients, ranging in age from 5 to 57 years with a mean age of 45 years. Pericardiectomy was performed via median sternotomy in 17 patients (Group A). In the remaining 16 patients (Group B), pericardiectomy was performed via a left anterolateral thoracotomy in the fifth intercostal space.

Results: During the subsequent follow-up, both groups of patients showed a similar and significant improvement in New York Heart Association (NYHA) functional class. In the group A, the mean NYHA functional class decreased from 3.3 0.7 to 1.8 0.5 (P = 0.0004). In group B, the mean functional class decreased from 3.2 0.9 to 1.6 0.6 (P = 0.00005). Also, both groups had a similar and significant improvement in their mean CVP. In the group A, the mean central venous pressure (CVP) decreased from 15.23.1 mmHg to 8.33.2 mmHg (P<0.005). In the group B, the mean CVP decreased from 15.14.9 mmHg to 7.72.4 mmHg (P<0.004).

Conclusion: Constrictive physiopathology is a problem primarily of the ventricles and can be alleviated by decorticating both the right and left ventricles. Therefore, CP could be relieved through the left thoracotomy or median sternotomy in most cases. However, echocardiographic findings should be considered to prefer thoracotomy or sternotomy approach.

KEY WORDS: Constrictive Pericarditis, Median Sternotomy, Thoracotomy.

Pak J Med Sci    October - December 2010    Vol. 26 No. 4    759-763

How to cite this article:

Ekim H, Basel H, Odabasi D, Tuncer M. Management of constrictive pericarditis: A comparative study between median sternotomy and left thoracotomy. Pak J Med Sci 2010;26(4):759-763


1. Hasan Ekim, MD,
Department of Cardiovascular Surgery
2. Halil Basel, MD,
Department of Cardiovascular Surgery
3. Dolunay Odabasi, MD,
Department of Cardiovascular Surgery
4. Mustafa Tuncer, MD,
Department of Cardiology
1-4: Yuzuncu Yil University,
Van, Turkey.

Correspondence:

Dr. Hasan Ekim
Yuzuncu Yil University
Tip Fakultesi Hastanesi
Maras Caddesi 65200 Van, Turkey.
E-mail: drhasanekim@yahoo.com

* Received for Publication: April 10, 2010
* Accepted: June 25, 2010



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