Surgical Treatment of Chronic Constrictive Pericarditis in a Developing Country

Background: Chronic constrictive pericarditis is a rare but serious clinical entity with a poor prognosis in the absence of surgical treatment. The purpose of this study was to report on our experience of subtotal anterior pericardectomy and analyze our surgical results. Results: We included 74 patients operated on for chronic constrictive pericarditis in our institution during the period from January 1985 to December 2020. There were 29 female and 45 male patients, with an average age of 28 years (range: 8 - 64 years). 36.5% of patients were in NYHA class III or IV. Physical signs were dominated by peripheral signs of right heart failure in 93.2% of cases. The surgical procedure was a subtotal anterior pericardectomy from the left to the right phrenic nerve, freeing the heart chambers and the large vessels. The surgical results were marked by a functional improvement in 82.4% of the cases. The postoperative complications were marked by a low cardiac output in 8.1% of the cases, a atrial fibrillation in 4.1% of the cases, a haemorrhage in 1.4% of the cases, a haemothorax in 2.7% of the cases. Perioperative mortality was 5.4% patients. The causes of death were low cardiac output in 50% of cases, hemorrhage in 25% of cases, and hepatocellular insufficiency in 25% of cases. We observed a mortality of 2.9% after an average follow-up of 5.17 years ± 4.76 years. All other survivors were asymptomatic and no re-intervention for recurrence was performed. Conclusions: Subtotal anterior pericardectomy was the technique we used for the treatment of chronic constrictive pericarditis. It allowed having satisfactory surgical results with a functional improvement and an acceptable morbidity.

Surgical Myocardial Revascularization in a Sub-Saharan African Country: Indications and Results

Introduction: Despite the advances of interventional catheterization, surgery remains the treatment of choice for some coronary lesions. Objective: To report the indications and results of surgical revascularization of the myocardium at the Abidjan Heart Institute. Patient and Methods: This is a retrospective study of patients with coronary insufficiency who underwent surgical myocardial revascularization between March 2014 and May 2020 in the Cardiovascular Surgery Department of the Abidjan Heart Institute. There were 17 patients, 11 of whom were men (64.7%) and 6 women (35.3%), The mean age of the patients was 57.5 years ± 8.8. All patients were symptomatic with disabling angina in class III of the Canadian Cardiac Society (CCS). This sym- ptomatology had been evolving on average for 5 years and 6 patients had a history of acute coronary syndrome, 2 of whom had undergone prior angioplasty. Coronary angiography revealed mono-truncated (17.6%), bi-truncated (23.5%) and tri-truncated (58.8%) lesions. Results: The patients were operated under cardiopulmonary bypass (CPB) 15 cases (88.2%) and off pump in 2 cases (11.8%). They underwent a single bypass in 23.5% of cases, a double bypass in 47.1% of cases and a triple bypass in 29.4% of cases. We observed 3 cases of complications (17.6%), namely transient acute renal failure, mediastinitis and postoperative bleeding. The operative and hospital mortality was nil. After a mean follow-up of 3 ± 1.8 years, all patients were asymptomatic with a negative stress test at last check-up. Conclusion: Our experience has allowed us to demonstrate the safe performance of surgical myocardial revascularization in our patients with satisfactory and encouraging results.