CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 8, September 2013
AFRICA
307
series reported by Sagrista-Sauleda
et al
. was also included in
this review with its 11 non-neoplastic patients.
2
Inour study, pre-operativeechocardiographyof allECPpatients
met the widely accepted criteria for ECP. Cardiac catheterisation
was performed without concomitant pericardiocentesis and
revealed equalisation of interventricular pressures in eight
patients. However, we lacked intra-operative haemodynamic data
regarding the effect of the presence and evacuation of pericardial
fluid. Histopathology of the pericardial fluid and tissue were
consistent with the underlying disease (Table 5). Five patients
died during follow up; two of these deaths occurred within the
first four months.
Similar to previous reports, our patients were unresponsive to
pericardiocentesis and subsequent aggressive medical therapy.
Although early mortality did not occur, the majority of our
patients had a complicated postoperative course. ECP has a
relatively long duration of symptoms and failure of repeated
pericardiocentesis attempts; therefore, echocardiography should
not be seen as a misleading diagnostic tool. The presence of signs
consistent with ECP should prompt early surgical intervention,
especially in patients with known underlying disease, such as
cancer or tuberculosis.
The prognosis depends on the underlying disease in cancer
patients, whereas patients with idiopathic ECP may respond to
subsequent medical treatment after pericardiocentesis. Patients
should be closely observed for the recurrence of symptoms;
re-accumulation of fluid should be considered as indicative of
disease persistence.
Conclusion
Pericardiectomy for ECP was effective, in terms of our early
results, in patients unresponsive to medical therapy. Long-term
survival depends on the underlying disease. The decision to delay
or not to delay surgery in specific aetiological subgroups should
be one of the main considerations for future studies on ECP.
References
1.
Hancock EW Subacute effusive-constrictive pericarditis.
Circulation
1971;
43
: 183–192
2.
Sagrista-Sauleda J, Angel J, Sanchez A, Permanyer-Miralda G, Soler–
Soler J. Effusive-constrictive pericarditis.
N Engl J Med
2004;
350
:
469–475.
3.
Ntsekhe M, Shey Wiysonge C, Commerford PJ, Mayosi BM. The prev-
alence and outcome of effusive constrictive pericarditis: a systematic
review of the literature. Ntsekhe M, Shey Wiysonge C, Commerford PJ,
Mayosi BM.
Cardiovasc J Afr
2012;
23
: 281–285
4.
Cameron J, Oesterle SN, Baldwin JC, Hancock EW. The etiologic
spectrum of constrictive pericarditis.
Am Heart J
1987;
113
: 354–360.
5.
Calvert PA, Bell AD, Lynch. Effusive constrictive pericarditis second-
ary to undifferentiated pericardial sarcoma.
Heart
2006;
92
: 1034.
6.
Sharma PS, Katechis D. Primary malignant pericardial mesothelioma
presenting as effusive-constrictive pericarditis.
J Invasive Cardiol
2011;
23
: 197–199.
7.
Nakayama Y, Ohtani Y, Kobayakawa N, Kobayashi J, KanekoY, Aoyagi
T. A case of early phase dialysis associated effusive constrictive peri-
carditis with distinct surgical findings.
Int Heart J
2009;
50
: 685–691.
8.
Harada T, Aoyagi T, Endo Y,
et al
. Effusive constrictive pericarditis due
to rheumatoid arthritis revealed by pericardiocentesis with simultane-
ous pressure recording – a case report.
Angiology
2002;
53
: 105–108.
9.
Ito M, TanabeY, Suzuki K,
et al
. A case of effusive-constrictive pericar-
ditis after cardiac surgery.
Mayo Clin Proc
2001;
76
: 555–558.
10. Garg R, Singh A, Chockalingam. Effusive constrictive pericarditis.
Congestive Heart Fail
2009;
15
: 199–201.
11. Imazio M. Risk of constrictive pericarditis after acute pericarditis.
Circulation
2011;
124
: 1270–1275.
12. Reuter H, Burgess LJ, LouwVJ, Doubell AF. The management of tuber-
culous pericardial effusion: experience in 233 consecutive patients.
Cardiovasc J S Afr
2007;
18
: 20–25.
13. Chowdhury UK, Subramaniam GK, Kumar AS,
et al
. Pericardiectomy
for constrictive pericarditis: a clinical, echocardiographic, and hemo-
dynamic evaluation of two surgical techniques.
Ann Thorac Surg
2006;
81
: 522–529.
14. Gongora E, Dearani JA, Orszulak TA,
et al.
Tricuspid regurgitation in
patients undergoing pericardiectomy for constrictive pericarditis.
Ann
Thorac Surg
2008;
85
: 163–170.
Cardiovascular congress diary 2013/2014
DATE
CONFERENCE
PLACE
CONTACT DETAILS TO REGISTER
OCTOBER 2013
10–12 October
Federation of Infectious Disease Society in South Africa (FIDSSA) Drakensberg, SA
13–16 October
10th international congress on coronary and artery disease from
prevention to intervention (ICCAD)
Florence, Italy
NOVEMBER 2013
16–20 November 86th American Heart Association scientific sessions (AHA)
Dallas, Texas, USA
Critical care refresher course 2013
SA
21–24 November 5th international conference of fixed combination in the treatment of
hypertension, dyslipidaemia and diabetes mellitus
Bangkok, Thailand
FEBRUARY 2014
20–23 February UCT Department of Medicine General Physicians Conference
Cape Town, SA
To advertise your conference/meeting, e-mail details and half-page high-resolution PDF advert to
