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The Panzer Heart: A Surgical Challenge

Received: 10 September 2016     Accepted: 11 October 2016     Published: 7 November 2016
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Abstract

Introduction constrictive pericarditis is an inflammation of pericardium, they develops progressive fibrotic, calcified the pericardium and compressed the myocardium. The aim of this study is to present a case of massive calcified pericardium and to describe the difficult of surgery. Method A 30–year-old woman was admitted in cardiovascular hospital after 7 years of dyspnea, weakness, fatigue, ascites and palpitation. She had been diagnosed with on tuberculosis 8 years before and had complied with anti-tuberculosis chemotherapy. Treatment consists of 4 drugs therapy (rifampicin, isoniazid, pyrazinamide and ethambutol) for 2 months followed by 2 drugs (rifampicin, isoniazid) for 4 months with adjuvant treatment including vitamin B. Clinical examination showed symptoms of right heart congestion including congestive liver; ascites dilated jugular vein and leg edema. Chest radiography showed massive pericardial calcific deposits encircling the left and the right ventricle. Two dimensional echocardiography revealed severe pericardial calcification with right systolic ventricular dysfunction, dilatation fright atrium and inferior vena cava. Chest thoracic scanner was performed and precise the topography of calcification. Right cardiac catheterism was not performed. Abdominal ultrasound showed ascites and cardiac-like liver. The transaminases were high. Result A subtotal pericardiectomy was performed through a median sternotomy without cardiopulmonary bypass (CPB).The anterior, lateral and inferior pericardium was resected between the right and left phrenic nerve using the ultrasonic scalpel. Massive calcified are as were first irrigated with hot physiologic serum, in order to fracture the plaque and dissect it from myocardium without coronary lesion. Our patient was discharged to the hospital 8 days later, electrocardiogram showed atrial fibrillation. After 3 months she no longer presents dyspnea and ascites. Conclusion Surgical decompression of right cardiac cavities in massive calcified pericarditis induce increasing of right signs and restoration of the right ventricular function.

Published in Journal of Surgery (Volume 4, Issue 6)
DOI 10.11648/j.js.20160406.11
Page(s) 126-129
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2016. Published by Science Publishing Group

Keywords

Calcific Pericarditis, Surgery, Tuberculosis

References
[1] Flecher E, Heautot JF, Abouliatim I,Leguerrier A. Calcified chronic constrictive pericarditis: an egg in the chest. European.J.Cardio.Thorac.Surg 2009;35:17
[2] Myers RB, Spodick DH. Constrictive pericarditis: clinical and pathophysiologic characteristics. Am Heart J 1999;138:219-32
[3] Ogunbanjo G, Ntusi N. Cardiovascular medicine in primary health care in sub-Saharan Africa: minimum standards for practice. S Afr Med J 2016;2:143-4
[4] McCaughan BC, Schaff HV, PiehlerJ M et al. Early and late results of pericardectomy for constrictive pericarditis. J Thorac Cardiovasc Surg 1985;89:340–50
[5] Yangni-Angate HK, Ayegnon G, Meneas C, Diby Fl, Tanauh Y, Diomande M. Yapobi Y. pericardites chroniques constrictives experience chirurgicale de 120 cas en Côte d’ivoire. Ann.Afr.Chir.Thor.Cardiovasc.2007;2:112-18
[6] Syed FF, Mayosi BM. A modern approach to tuberculous pericarditis Prog Cardiovasc Dis 2007;50(3):218-36
[7] Madeira M, Texeira R, CostaM, Gonçalves L, Klein AL. Two–dimensional speckle tracking cardiac mechanics and constrictive pericarditis: systematic review. Echocardiography 2016;19;10.1111/13293
[8] Tse G, Ali A, Alpendurada F, Prasad S, Raphael CE, Vassiliou V. Tuberculous constrictive pericarditis. Res Cardiovasc Med 2015;4e Collectione 29614
[9] Copeland JG, Stinson EB, Griepp RB, Shumway NE. Surgical treatment of chronic constrictive pericarditis using cardio pulmonary bypass. ThoracCardiovasc Surg 1975;69:236-8
[10] Ciss AG, Dieng PA, Ba S, N’diaye A, Diatta S, Ndiaye M. Indications et résultats de la chirurgie de la péricardite chronique constrictive à Dakar. Journal Africain de Chirurgie 2011;1:139-42
[11] Fukumoto A, Yamagishi M, Doi K, Ogawa M, Inoue T, Yaku H. Off-pump pericardiectomy using ultrasonic scalpel and a heart positioner. Asian Cardiovasc Thorac Ann 2007;15:e69-71
[12] Karthigesu A, Hamdan L, Arif M, Haslan G. A case of successful extracorporeal membrane oxygenation for right ventricular failure following pericardiectomy. Med J Malaysia. 2015;70:369-70
[13] Biçer M, Ozdemir B, KanI, Yuksel A, Tok M, Senkaya I. Long-term outcomes of pericardiectomy for constrictive pericarditis. J Cardio thorac Surg 2015;10:177
[14] Inamdar KY, Alkebaier M, Lijunhong, Abudunaibi, Mulati A. Pericardiectomy: prompt surgical management of constrictive pericarditis. Heart Surg Forum 2014;17:319-22
[15] Bozbuga N, Erentug V, Eren E, Erdogan HB, Kirali K, AntalA, Akinci E, Yakut C. Pericardiectomy for chronic constrictive tuberculous pericarditis: risks and predictors of survival. Tex Heart Inst J 2003;30: 180-5
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  • APA Style

    Ciss Amadou Gabriel, Gandji E.Wilfried, Diop Momar Sokhna, Ba Papa Salmane, Leye Mohamed, et al. (2016). The Panzer Heart: A Surgical Challenge. Journal of Surgery, 4(6), 126-129. https://doi.org/10.11648/j.js.20160406.11

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    ACS Style

    Ciss Amadou Gabriel; Gandji E.Wilfried; Diop Momar Sokhna; Ba Papa Salmane; Leye Mohamed, et al. The Panzer Heart: A Surgical Challenge. J. Surg. 2016, 4(6), 126-129. doi: 10.11648/j.js.20160406.11

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    AMA Style

    Ciss Amadou Gabriel, Gandji E.Wilfried, Diop Momar Sokhna, Ba Papa Salmane, Leye Mohamed, et al. The Panzer Heart: A Surgical Challenge. J Surg. 2016;4(6):126-129. doi: 10.11648/j.js.20160406.11

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  • @article{10.11648/j.js.20160406.11,
      author = {Ciss Amadou Gabriel and Gandji E.Wilfried and Diop Momar Sokhna and Ba Papa Salmane and Leye Mohamed and Sene Etienne Birame and Diatta Souleymane and Gaye Magaye and Dieng Papa Adama and N’diaye Assane and N’diaye Mouhamadou},
      title = {The Panzer Heart: A Surgical Challenge},
      journal = {Journal of Surgery},
      volume = {4},
      number = {6},
      pages = {126-129},
      doi = {10.11648/j.js.20160406.11},
      url = {https://doi.org/10.11648/j.js.20160406.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20160406.11},
      abstract = {Introduction constrictive pericarditis is an inflammation of pericardium, they develops progressive fibrotic, calcified the pericardium and compressed the myocardium. The aim of this study is to present a case of massive calcified pericardium and to describe the difficult of surgery. Method A 30–year-old woman was admitted in cardiovascular hospital after 7 years of dyspnea, weakness, fatigue, ascites and palpitation. She had been diagnosed with on tuberculosis 8 years before and had complied with anti-tuberculosis chemotherapy. Treatment consists of 4 drugs therapy (rifampicin, isoniazid, pyrazinamide and ethambutol) for 2 months followed by 2 drugs (rifampicin, isoniazid) for 4 months with adjuvant treatment including vitamin B. Clinical examination showed symptoms of right heart congestion including congestive liver; ascites dilated jugular vein and leg edema. Chest radiography showed massive pericardial calcific deposits encircling the left and the right ventricle. Two dimensional echocardiography revealed severe pericardial calcification with right systolic ventricular dysfunction, dilatation fright atrium and inferior vena cava. Chest thoracic scanner was performed and precise the topography of calcification. Right cardiac catheterism was not performed. Abdominal ultrasound showed ascites and cardiac-like liver. The transaminases were high. Result A subtotal pericardiectomy was performed through a median sternotomy without cardiopulmonary bypass (CPB).The anterior, lateral and inferior pericardium was resected between the right and left phrenic nerve using the ultrasonic scalpel. Massive calcified are as were first irrigated with hot physiologic serum, in order to fracture the plaque and dissect it from myocardium without coronary lesion. Our patient was discharged to the hospital 8 days later, electrocardiogram showed atrial fibrillation. After 3 months she no longer presents dyspnea and ascites. Conclusion Surgical decompression of right cardiac cavities in massive calcified pericarditis induce increasing of right signs and restoration of the right ventricular function.},
     year = {2016}
    }
    

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  • TY  - JOUR
    T1  - The Panzer Heart: A Surgical Challenge
    AU  - Ciss Amadou Gabriel
    AU  - Gandji E.Wilfried
    AU  - Diop Momar Sokhna
    AU  - Ba Papa Salmane
    AU  - Leye Mohamed
    AU  - Sene Etienne Birame
    AU  - Diatta Souleymane
    AU  - Gaye Magaye
    AU  - Dieng Papa Adama
    AU  - N’diaye Assane
    AU  - N’diaye Mouhamadou
    Y1  - 2016/11/07
    PY  - 2016
    N1  - https://doi.org/10.11648/j.js.20160406.11
    DO  - 10.11648/j.js.20160406.11
    T2  - Journal of Surgery
    JF  - Journal of Surgery
    JO  - Journal of Surgery
    SP  - 126
    EP  - 129
    PB  - Science Publishing Group
    SN  - 2330-0930
    UR  - https://doi.org/10.11648/j.js.20160406.11
    AB  - Introduction constrictive pericarditis is an inflammation of pericardium, they develops progressive fibrotic, calcified the pericardium and compressed the myocardium. The aim of this study is to present a case of massive calcified pericardium and to describe the difficult of surgery. Method A 30–year-old woman was admitted in cardiovascular hospital after 7 years of dyspnea, weakness, fatigue, ascites and palpitation. She had been diagnosed with on tuberculosis 8 years before and had complied with anti-tuberculosis chemotherapy. Treatment consists of 4 drugs therapy (rifampicin, isoniazid, pyrazinamide and ethambutol) for 2 months followed by 2 drugs (rifampicin, isoniazid) for 4 months with adjuvant treatment including vitamin B. Clinical examination showed symptoms of right heart congestion including congestive liver; ascites dilated jugular vein and leg edema. Chest radiography showed massive pericardial calcific deposits encircling the left and the right ventricle. Two dimensional echocardiography revealed severe pericardial calcification with right systolic ventricular dysfunction, dilatation fright atrium and inferior vena cava. Chest thoracic scanner was performed and precise the topography of calcification. Right cardiac catheterism was not performed. Abdominal ultrasound showed ascites and cardiac-like liver. The transaminases were high. Result A subtotal pericardiectomy was performed through a median sternotomy without cardiopulmonary bypass (CPB).The anterior, lateral and inferior pericardium was resected between the right and left phrenic nerve using the ultrasonic scalpel. Massive calcified are as were first irrigated with hot physiologic serum, in order to fracture the plaque and dissect it from myocardium without coronary lesion. Our patient was discharged to the hospital 8 days later, electrocardiogram showed atrial fibrillation. After 3 months she no longer presents dyspnea and ascites. Conclusion Surgical decompression of right cardiac cavities in massive calcified pericarditis induce increasing of right signs and restoration of the right ventricular function.
    VL  - 4
    IS  - 6
    ER  - 

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Author Information
  • Service de Chirurgie Thoracique et Cardiovasculaire CHNU FANN, Department of Thoracic and Cardiovascular Surgery FANN, University Hospital, Dakar, Senegal

  • Service de Chirurgie Thoracique et Cardiovasculaire CHNU FANN, Department of Thoracic and Cardiovascular Surgery FANN, University Hospital, Dakar, Senegal

  • Service de Chirurgie Thoracique et Cardiovasculaire CHNU FANN, Department of Thoracic and Cardiovascular Surgery FANN, University Hospital, Dakar, Senegal

  • Service de Chirurgie Thoracique et Cardiovasculaire CHNU FANN, Department of Thoracic and Cardiovascular Surgery FANN, University Hospital, Dakar, Senegal

  • Service de Chirurgie Thoracique et Cardiovasculaire CHNUFANN, Department of Cardiology FANN University Hospital, Dakar, Senegal

  • Service de Chirurgie Thoracique et Cardiovasculaire CHNUFANN, Department of Anesthesiology FANN University Hospital, Dakar, Senegal

  • Service de Chirurgie Thoracique et Cardiovasculaire CHNU FANN, Department of Thoracic and Cardiovascular Surgery FANN, University Hospital, Dakar, Senegal

  • Service de Chirurgie Thoracique et Cardiovasculaire CHNU FANN, Department of Thoracic and Cardiovascular Surgery FANN, University Hospital, Dakar, Senegal

  • Service de Chirurgie Thoracique et Cardiovasculaire CHNU FANN, Department of Thoracic and Cardiovascular Surgery FANN, University Hospital, Dakar, Senegal

  • Service de Chirurgie Thoracique et Cardiovasculaire CHNU FANN, Department of Thoracic and Cardiovascular Surgery FANN, University Hospital, Dakar, Senegal

  • Service de Chirurgie Thoracique et Cardiovasculaire CHNU FANN, Department of Thoracic and Cardiovascular Surgery FANN, University Hospital, Dakar, Senegal

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