Author(s)

Ahmed Abdelrahman Elassal^1,2*, Osman Osama Al-Radi¹, Husain Hamza Jabbad¹, Zaher Faisal Zaher³, Mohamed Hasan Abdelsalam^3,4, Ahmed Mohamed Dohain^3,5, Gaser Abdelmohsen Abdelmohsen^3,5, Khalid Ebrahim Al-Ebrahim¹

¹Cardiac Surgery Unit, King Abdulaziz University, Jeddah, Saudi Arabia.
²Cardiothoracic Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
³Pediatric Cardiology Division, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
⁴Department of Cardiology, Faculty of Medicine, Benha University, Benha, Egypt.
⁵Cardiology Division, Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt.

Background: The knowledge on pericardial disease has increased but the European Society of Cardiology in the last guidelines 2015 stated a section of perspective and unmet needs referring to the surgical management as one of these needs. Here, we present an institutional experience to contribute with other studies in explanation of questionable aspects about their surgical management. Methods: Among 127 cases (93 adults and 34 children) that were diagnosed as pericardial syndrome, we retrospectively analyzed 45 cases (40 adults and 5 children) operated for pericardial syndrome from May 2012 to June 2019. Echocardiogram was the main preoperative diagnostic tool. Surgical approach was selected according to each diagnosis. Postoperative clinical assessment, recurrence and mortality rate were the main determinants of outcome. Results: Regarding pericardial effusions, the mean preoperative medical treatment period was 17.7 ± 21.9 days and pericardial window through thoracotomy was the common approach (54.5%). In constrictive pericarditis, infection was the main etiology (40%), mean preoperative medical treatment period was 16 ± 8.8 days and complete pericardiectomy was the surgical procedure for most cases. Trans-sternal drainage was the standard approach for cardiac tamponade. No postoperative same admission recurrences were reported and 11 (24.4%) mortalities were recorded, 7 (15.5%) cases of them were diagnosed as malignant effusions. Conclusion: Decision making and surgical approach affect the outcome of surgery for pericardial syndromes. Children are more responsive to medical treatment than adults are. Primary etiology and patient’s condition are still the leading determinants of morbidity and mortality.

Surgery, Pericardial Syndromes, Adults, Children

Elassal, A. , Al-Radi, O. , Jabbad, H. , Zaher, Z. , Abdelsalam, M. , Dohain, A. , Abdelmohsen, G. and Al-Ebrahim, K. (2020) Surgery for Pericardial Syndromes in Adults and Children: Clarification of Questionable Aspects. World Journal of Cardiovascular Surgery, 10, 213-225. doi: 10.4236/wjcs.2020.1011024.