Surgery for Pericardial Syndromes in Adults and Children: Clarification of Questionable Aspects

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.

Pericardial Strip versus Ring Annuloplasty for Repair of Functional Tricuspid Regurgitation

Background: Functional tricuspid regurgitation is a challenge regarding indications for repair and proper surgical technique. Aim of the study: We reviewed our midterm results of tricuspid valve repair for functional regurgitation comparing pericardial strip versus ring annuloplasties. Patients and methods: From January 2008 to December 2013, we operated 59 patients (male:female, 41:18, with a mean age of 34 ± 14 years) for functional tricuspid regurgitation. Tricuspid annuloplasty was done using pericardial strip in 39 patients and ring in 20 patients. Concomitant procedures were mitral valve replacement in 66% of patients, aortic valve replacement in 5% and double valve replacement in 29%. Clinical and echocardiographic data were collected. Results: Preoperative characteristics of the two groups were similar regarding age, percentage of female patients, New York Heart Association functional class and pulmonary artery pressure. More patients with preoperative right ventricular dysfunction were found in pericardial annuloplasty group although this was not statistically significant (13 versus 5;P = 0.52). Operative times were similar in both groups. We had one mortality case (1.69%) due to low cardiac output in the pericardial group. Postoperative complications included reexploration for bleeding in one patient and chronic heart failure in another patient. The average follow up period was 3 years and it was complete in 100% of patients. Postoperative freedom from recurrent moderate tricuspid regurgitation was 90% in both groups. Conclusion: Pericardial strip annuloplasty is a simple, inexpensive, reproducible and efficient technique that has comparable results to ring annuloplasty.

Hybrid Repair of Two Consecutive Acute Ventricular Septal Ruptures after Evolving Myocardial Infarction: Case Report

Background: Acute Ventricular septal rupture is one of dreadful complications of acute evolving myocardial infarction. Despite urgent management is lifesaving, it is still challenging and has a high risk of mortality particularly if recurrent or residual defects occurred. Evolving of skillfulness in transcatheter intervention of heart diseases paved the way for successful hybrid management of challenging cardiac cases specially for residual complicated cases post cardiac surgery. Case Presentation: We described here a successful hybrid two stage technique (surgical then transcatheter approach) to close two consecutive acute ventricular septal ruptures in 75 years old female presented with cardiogenic shock post evolving myocardial infarction. Conclusion: Hybrid repair by surgical and transcatheter interventions may be a good therapeutic modality for acute septal ruptures specially for residual or new defects after initial closure.