The Panzer Heart: A Surgical Challenge
Journal of Surgery
Volume 4, Issue 6, December 2016, Pages: 126-129
Received: Sep. 10, 2016; Accepted: Oct. 11, 2016; Published: Nov. 7, 2016
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Authors
Ciss Amadou Gabriel, Service de Chirurgie Thoracique et Cardiovasculaire CHNU FANN, Department of Thoracic and Cardiovascular Surgery FANN, University Hospital, Dakar, Senegal
Gandji E.Wilfried, Service de Chirurgie Thoracique et Cardiovasculaire CHNU FANN, Department of Thoracic and Cardiovascular Surgery FANN, University Hospital, Dakar, Senegal
Diop Momar Sokhna, Service de Chirurgie Thoracique et Cardiovasculaire CHNU FANN, Department of Thoracic and Cardiovascular Surgery FANN, University Hospital, Dakar, Senegal
Ba Papa Salmane, Service de Chirurgie Thoracique et Cardiovasculaire CHNU FANN, Department of Thoracic and Cardiovascular Surgery FANN, University Hospital, Dakar, Senegal
Leye Mohamed, Service de Chirurgie Thoracique et Cardiovasculaire CHNUFANN, Department of Cardiology FANN University Hospital, Dakar, Senegal
Sene Etienne Birame, Service de Chirurgie Thoracique et Cardiovasculaire CHNUFANN, Department of Anesthesiology FANN University Hospital, Dakar, Senegal
Diatta Souleymane, Service de Chirurgie Thoracique et Cardiovasculaire CHNU FANN, Department of Thoracic and Cardiovascular Surgery FANN, University Hospital, Dakar, Senegal
Gaye Magaye, Service de Chirurgie Thoracique et Cardiovasculaire CHNU FANN, Department of Thoracic and Cardiovascular Surgery FANN, University Hospital, Dakar, Senegal
Dieng Papa Adama, Service de Chirurgie Thoracique et Cardiovasculaire CHNU FANN, Department of Thoracic and Cardiovascular Surgery FANN, University Hospital, Dakar, Senegal
N’diaye Assane, Service de Chirurgie Thoracique et Cardiovasculaire CHNU FANN, Department of Thoracic and Cardiovascular Surgery FANN, University Hospital, Dakar, Senegal
N’diaye Mouhamadou, Service de Chirurgie Thoracique et Cardiovasculaire CHNU FANN, Department of Thoracic and Cardiovascular Surgery FANN, University Hospital, Dakar, Senegal
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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.
Keywords
Calcific Pericarditis, Surgery, Tuberculosis
To cite this article
Ciss Amadou Gabriel, Gandji E.Wilfried, Diop Momar Sokhna, Ba Papa Salmane, Leye Mohamed, Sene Etienne Birame, Diatta Souleymane, Gaye Magaye, Dieng Papa Adama, N’diaye Assane, N’diaye Mouhamadou, The Panzer Heart: A Surgical Challenge, Journal of Surgery. Vol. 4, No. 6, 2016, pp. 126-129. doi: 10.11648/j.js.20160406.11
Copyright
Copyright © 2016 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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