Abstract: Background. Constrictive pericarditis is a rare chronic inflammatory disease that impairs diastolic filling, reduces cardiac output, and ultimately leads to heart failure. TB and post-pericardiotomy and idiopathic are the commonest causes. Multimodality imaging are essential for confirming the diagnosis Trans-thoracic echocardiography is the golden method of diagnosis. Computed tomography is another confirmatory diagnostic tool of pericardial thickness. Right side heart Cath and magnetic resonance imaging help in diagnosis of constrictive pericarditis from restrictive cardiomyopathy and confirm diastolic filling dysfunction of the heart. Pericardiectomy is the mainstay therapy, should be early and complete if feasible to provide symptoms relieve and adequate outcome Patients and methods. We retrospectively review medical records of 13 patients operated for pericardiectomy for constrictive pericarditis. Demographic and perioperative data were analyzed. Results. The mean age of patients was 49.9±7.8 years. All of our patients were symptomatic (NYHA class II-IV) with 7 months median duration of symptoms. TB was the commonest cause. Complete pericardiectomy was achieved in 11 patients (84.6%). Cardiopulmonary bypass was conducted in 5 patients (4 for associated cardiac procedure and one for repair of IVC injury). NYHA class improved to class I in 9 patients (75%). We had one case (7.6%) of mortality. The cause of death was sepsis and respiratory failure. Conclusion. Phrenic to phrenic pericardiectomy without bypass is safe and effective for treating constrictive pericarditis.Abstract: Background. Constrictive pericarditis is a rare chronic inflammatory disease that impairs diastolic filling, reduces cardiac output, and ultimately leads to heart failure. TB and post-pericardiotomy and idiopathic are the commonest causes. Multimodality imaging are essential for confirming the diagnosis Trans-thoracic echocardiography is the golden...Show More
Abstract: Systemic venous collaterals may cause an inordinate amount of hypoxemia or an unsustainable oxygen requirement after single ventricle palliation with a superior cavopulmonary anastomosis. Anterior venous collaterals are easily identified by injections of contrast in the superior vena cava or innominate vein during heart catheterization (venography), while posterior venous collaterals may be overlooked. This report describes how well posterior systemic venous collaterals were identified by venography and CT angiography in five affected patients after a superior cavopulmonary anastomosis. The medical records and images of patients with evidence of prominent posterior systemic venous collaterals after a superior cavopulmonary anastomosis were retrospectively reviewed. Five patients with prominent posterior systemic venous collaterals were identified between 2008 and 2019. Posterior venous collaterals were identified by venography after initial identification by CT angiography in one patient; by CT angiography when overlooked by venography in three patients; and by repeat venography when overlooked by venography during an initial heart catheterization. Three patients survived without inordinate hypoxemia following closure of posterior venous collaterals. The collateral veins were occluded with access through vessels entering the inferior vena cava in two patients and vessels originating from the innominate vein in one patient. Two patients died without closure of posterior venous collaterals. All patients were treated with pulmonary vasodilators without sufficient improvement to prevent a need for intervention or death. In conclusion, posterior venous collaterals were seen well by CT angiography even when overlooked by venography in patients with inordinate hypoxemia following a superior cavopulmonary anastomosis. CT angiograms may also define the course of collaterals and provide guidance for interventions during heart catheterization.Abstract: Systemic venous collaterals may cause an inordinate amount of hypoxemia or an unsustainable oxygen requirement after single ventricle palliation with a superior cavopulmonary anastomosis. Anterior venous collaterals are easily identified by injections of contrast in the superior vena cava or innominate vein during heart catheterization (venography)...Show More