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Pericardiectomy in children <15 years of age

Published online by Cambridge University Press:  10 July 2013

Sachin Talwar ,
Vinitha Viswambharan Nair ,
Shiv Kumar Choudhary ,
Vishnubhatla Sreeniwas ,
Anita Saxena ,
Rajnish Juneja ,
Shyam Sunder Kothari  and
Balram Airan
Sachin Talwar*
Affiliation:
Cardiothoracic Center and Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
Vinitha Viswambharan Nair
Affiliation:
Cardiothoracic Center and Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
Shiv Kumar Choudhary
Affiliation:
Cardiothoracic Center and Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
Vishnubhatla Sreeniwas
Affiliation:
Cardiothoracic Center and Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
Anita Saxena
Affiliation:
Cardiothoracic Center and Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
Rajnish Juneja
Affiliation:
Cardiothoracic Center and Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
Shyam Sunder Kothari
Affiliation:
Cardiothoracic Center and Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
Balram Airan
Affiliation:
Cardiothoracic Center and Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
*
Correspondence to: S. Talwar, Additional Professor, Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi-110029, India. Tel: 91-11-26594835; Fax: 91-11-26588663; E-mail: sachintalwar@hotmail.com
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Abstract

Between January, 2002 and December, 2011, 27 patients (19 boys) underwent pericardiectomy. The mean age was 9.3 ± 4.96 years (range 0.4 to 15 years) and the mean duration of symptoms was 16.9 ± 22.15 months. In all, 25 patients had dyspnoea; eight were in New York Heart Association (NYHA) class IV; six had bacterial pericarditis; and 18 were on anti-tuberculosis treatment, although only nine had records suggesting tuberculosis. There were nine patients who underwent pre-operative pigtail catheter drainage of pericardial fluid. Surgical procedures were complete pericardiectomy (n = 20), partial pericardiectomy (n = 6), and pleuropericardial window (n = 1).The mean pre-operative right atrial pressure was 20.4 ± 4.93 mmHg. There were six hospital deaths due to low cardiac output (n = 5) and arrhythmia (n = 1). The mean intensive care unit stay was 2.7 ± 1.2 days and mean post-operative stay was 9.9 days. The mean right atrial pressure dropped to 8.7 ± 1.15 mmHg. Adverse outcomes defined as death/prolonged intensive care unit stay, prolonged post-operative stay were not associated with sex, diagnosis of tuberculosis or pyopericardium, or the duration of symptoms or pre-operative right atrial pressure. Younger patients had prolonged intensive care unit stay (p = 0.03) but not increased mortality. Advanced NYHA class predicted death (p = 0.02). The mean follow-up was 23.1 ± 23.8 months. All except one survivor are in NYHA class I and off all cardiac medications. Despite adequate surgery, pericardiectomy in children is associated with a high mortality, which is related to delayed surgery and poor pre-operative general condition. No specific pre-operative variable other than worse pre-operative NYHA class is a predictor of survival. Therefore, early pericardiectomy should be undertaken in such patients.

Keywords

Constrictive pericarditistuberculosispericardiectomy
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 4 , August 2014 , pp. 616 - 622
Copyright
Copyright © Cambridge University Press 2013 

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