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Surgery

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Thyroid & Adrenal

Question
2 out of 99
 

Curative treatment of chronic constrictive pericarditis is:



A Conservative.
B Pericardiectomy

C Pericardiocentesis
D Pericardial window

Ans. B Pericardiectomy (REF. SABISTON SURGERY 18TH EDN PG 1872)

Complete pericardectomy is the definitive therapy and is a potential cure.

a. Results are better if the procedure is performed earlier in the course, when less calcification is present and when the chance of abnormal myocardium or advanced heart failure is reduced.

b. Some judgment is required because patients who are asymptomatic (NYHA class I) or who have early NYHA stage II symptoms may be clinically stable for years.

c. Pericardial decortication should be as extensive as possible, especially at the diaphragmatic-ventricular contact regions. The surgical procedure can be long and is often technically complex.

d. 80-90% of patients who undergo pericardectomy achieve NYHA class I or II postoperatively.

e. Persistent diastolic filling abnormalities tend to occur in patients who have a longer history of preoperative symptoms

f. Cardiac mortality and morbidity seems to be related to presurgical myocardial atrophy or fibrosis, which can be detected using CT. Excluding these patients keeps the mortality rate at the lower end of the range (5%).

g. Postoperative low cardiac output can be treated in the usual fashion, including vasoactive pressors and intra-aortic balloon pump (IABP), if necessary.

h. Medical management is generally ineffective in the vast majority of cases unless a prominent inflammatory component is present.

i. In acute pericarditis, in which the use of nonsteroidal anti-inflammatory agents, cyclooxygenase-2 inhibitors, colchicine, corticosteroids, or a combination thereof may provide benefit.

j. Subacute constrictive pericarditis may respond to steroids if treated before pericardial fibrosis occurs.

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