Pericardiectomy for treatment of neoplastic constrictive pericarditis

Our plain-English summary of Pericardiectomy for treatment of neoplastic constrictive pericarditis, by F. Buyukbayrak, E. Aksoy, M. Dedemoglu, et al (Asian Cardiovascular & Thoracic Annals, 2014).

The study

• Authors: F. Buyukbayrak, E. Aksoy, M. Dedemoglu, K. Kirali, H.M. Alp
• Journal: Asian Cardiovascular & Thoracic Annals
• Published: 2014;22(3):296-300
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: To share our results of a case series of 8 patients who underwent pericardiectomy for constrictive pericarditis that developed secondary to a known neoplastic disease.

Patients And Methods: The underlying neoplasia was lung cancer in 5 (62.5%) patients, malignant pleural mesothelioma in 2 (25%), and Hodgkin lymphoma in 1 (12.5%). A diagnosis of constrictive pericarditis was made primarily by echocardiography, and right heart catheterization was performed in 6 (75%) patients. Total pericardiectomy was defined as wide excision of the anterior pericardium. Follow-up information was obtained by telephone interview and the civil registry database.

Results: Time from initial diagnosis of the neoplastic disease ranged from 1 to 15 years. Total pericardiectomy was performed in 6 (75%) patients. Histopathological examination revealed atypical cells in evacuated fluid and pericardial material in 6 patients. Nonspecific inflammation and fibrosis were observed in the other 2 cases. Hospital death occurred in 1 (12.5%) patient. Postoperative low cardiac output syndrome occurred in 7 (87.5%) patients. Follow-up ranged from 2.92 to 26.78 months. Mean survival was 14.82 ± 4.4 months.

Conclusion: Pericardial constriction may develop a long time after the initial presentation of certain neoplastic diseases, and the prognosis after pericardiectomy is poor.

In plain English

This retrospective case series from an Istanbul heart hospital reviewed 8 patients operated on for a thickened, constricting pericardium (the sac around the heart) linked to cancer. Wide removal of the front of the pericardium, which the authors called total, was done in 6; removal was partial in 2. Five had lung cancer, 2 had malignant pleural mesothelioma and 1 had Hodgkin lymphoma. The article does not mention asbestos or any asbestos exposure. Known cancers had been diagnosed 1 to 15 years earlier; in one patient, lung cancer was found only after surgery. One patient (12.5%) died in hospital. Heart failure symptoms improved early in 5 patients. Over 2.92 to 26.78 months of follow-up, mean survival was 14.82 plus or minus 4.4 months. The authors wrote that most patients died within the first postoperative year; their patient table shows 4 of the 8 died within it. One mesothelioma patient died of advanced heart failure at 19.71 months; the other was lost to follow-up at 11.99 months. The authors concluded that constriction may develop long after some cancers appear, and that prognosis after pericardiectomy is poor.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective case series based on review of clinical records
• Who was studied: 8 patients who underwent pericardiectomy for constrictive pericarditis linked to cancer at Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey. Underlying cancers were lung cancer in 5 (62.5%), malignant pleural mesothelioma in 2 (25%) and Hodgkin lymphoma in 1 (12.5%). One patient had no history of malignancy before surgery and was later diagnosed with small-cell lung carcinoma. The study dates are not given.
• Exposure: No asbestos or other fiber exposure is reported for any patient. The study concerns surgery (pericardiectomy) in patients with cancer-related pericardial constriction. All patients had received systemic chemotherapy, and 2 had received radiotherapy. Table 1 lists tobacco use in 2 (25%).
• Main results:
  • Time from first diagnosis of the cancer ranged from 1 to 15 years. One patient had no history of malignancy before surgery. That cancer was diagnosed afterward, and Table 3 gives that patient's interval as 0.
  • Total pericardiectomy, which the authors defined as wide excision of the anterior pericardium, was done in 6 of 8 patients. It was partial in the other 2.
  • The pericardium could not be totally excised in 2 patients.
  • Atypical cells were found in the removed fluid and pericardial tissue in 6 of the 8 patients.
  • 1 of 8 patients (12.5%) died in hospital after the operation.
  • The text reports postoperative low cardiac output syndrome in 7 of 8 patients (87.5%). Table 2 lists 4 (50%).
  • Heart failure symptoms improved early after surgery in 5 of 8 patients (62.5%).
  • Follow-up ranged from 2.92 to 26.78 months. Mean survival (Kaplan-Meier) was 14.82 plus or minus 4.4 months.
  • The authors wrote that most patients died within the first postoperative year. Counted from Table 3, 4 of the 8 patients died within the first year, including the hospital death. Two others died later (at 19.71 and 26.78 months), one was lost to follow-up, and one was alive.
  • The 2 mesothelioma patients had direct invasion of malignant mesothelioma into the mediastinum.
  • In Table 3, mesothelioma patient no. 3 died of advanced heart failure after 19.71 months of follow-up.
  • In Table 3, mesothelioma patient no. 6 was lost to follow-up at 11.99 months.
• The authors' conclusion: The authors concluded that pericardial constriction may develop a long time after certain cancers first appear, and that prognosis after pericardiectomy is poor.
• Limitations the authors state:
  • The authors note that it is uncertain whether the deaths were due to advanced cancer rather than heart failure.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pericardiectomy, Lung Cancer, Pleural Mesothelioma, Pericardium, Pericardial, Inflammation, Fibrosis, Prognosis.

Related studies

• Constrictive pericarditis after left extrapleural pneumonectomy and radiotherapy for malignant mesothelioma — E.J. Hickey, A.A. Khan, et al. (2007)
• Constrictive pericarditis in a patient with fiberglass lung disease: a case report — C.Y. Hsu, H.Y. Chen, et al. (2024)
• Asbestos induced pericardial effusion and constrictive pericarditis — D. Davies, M.I. Andrews, et al. (1991)
• Chronic constrictive pericarditis associated with asbestosis — L. Fischbein, M. Namade, et al. (1988)
• 18F-FDG PET/CT Revealing Constrictive Pericarditis as the Only Manifestation of Malignant Mesothelioma — J.P. Edel, H. Balink (2019)
• A case of pleural mesothelioma with effusive-constrictive pericarditis — N.A. Weir, B. Gerstenhaber (2001)

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