Experience of Pericardiectomy in Tikur Anbessa University Hospital, Ethiopia

Background: Pericardiectomy is the only accepted curative treatment for improving cardiac haemodynamics in chronic constrictive pericarditis (CCP). This study was aimed at reviewing the experience and functional outcome of patients undergoing Pericardiectomy in Tikur Anbessa Hospital between January 1996 and December 2005.
Methods: This was a retrospective Analysis done at the Thoracic Surgical unit, Tikur Anbessa Hospital, Department of Surgery, Medical Faculty, Addis Ababa University, Addis Ababa, Ethiopia. During the period under review, 26 patients underwent Pericardiectomy for CCP. Medical records and operation theatre registers of 19 patients were retrieved and analysed.
Results: Thirteen of the patients were males and six were females (M: F=2.2:1) The ages ranged from 14 to 42 years (mean 24.3±7). The duration of illness ranged between 2 and 36 months with a mean of 15.2±10.8). Diagnosis of constrictive pericarditis was based on the clinical picture of right sided heart failure along with chest roentgenogram, electrocardiogram, echocardiography and histological examinations. The most common presenting symptoms were dyspnea in 19 (100%) patients, abdominal discomfort in 14 (73.7%) and abdominal distension in 11 (68.4%) patients. On physical examination raised JVP, peripheral edema, hepatomegaly and ascites were seen in the majority of cases. Chest x-ray revealed pleural effusion in 12 (63.2%) patients, enlarged cardiac silhouette in 9 (47.4%) and pericardial calcification in 7 (36.8%). ECG showed low QRS voltage and T wave abnormality in 10 (52.6%) and 9 (42.1%) cases respectively. Pericardial thickening/calcification (52.6%), left ventricular septa motion abnormality (42.1%) and pericardial effusion (36.8%) were seen by echocardiography. The surgical approach was mainly median sternotomy in 15 (79%) patients, and the mean operation time was 112 (range 90-135±18.9) minutes. Fifteen (79%) patients had uneventful postoperative course. Two patients developed pneumonia and one a hydropneumothorax. There was one death in the immediate postoperative period. Long–term mortality of 10.5% was noted. Mean hospital stay and follow-up time were 14.3±5.3 (range 7-24) days and 12.8±6.9 (range 3-24) months respectively.
Conclusion: Pericardiectomy can be performed without the use of CPB and with low mortality, and can result in an improved functional capacity in the majority of the patients.