pericardiectomy

出典: meddic

収縮性心膜炎
  • 収縮性心膜炎の根治療法。
  • 心膜炎により心嚢水が貯留し、心機能が低下する場合にも行う(参考1)、らしい。


参考

  • 1.
[display]http://www.debakeydepartmentofsurgery.org/home/content.cfm?proc_name=pericardiectomy&content_id=274


Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2017/03/05 13:11:02」(JST)

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英文文献

  • Purulent pericarditis after transbronchial biopsy.
  • Tachjian A1, Shafer KM2, Denkinger C1, Pinto DS3.
  • The Canadian journal of cardiology.Can J Cardiol.2014 Oct;30(10):1250.e19-21. doi: 10.1016/j.cjca.2014.04.013. Epub 2014 Apr 18.
  • A 28-year-old woman experienced hypotension and unresponsiveness. She had undergone bronchoscopy with needle biopsy 2 weeks before admission to evaluate hilar lymphadenopathy given suspicion of sarcoidosis. She had an elevated white blood cell count of 28,000/μL and a serum creatinine level of 4.0
  • PMID 25138484
  • Constrictive pericarditis--a curable diastolic heart failure.
  • Syed FF1, Schaff HV2, Oh JK1.
  • Nature reviews. Cardiology.Nat Rev Cardiol.2014 Sep;11(9):530-44. doi: 10.1038/nrcardio.2014.100. Epub 2014 Jul 29.
  • Constrictive pericarditis can result from a stiff pericardium that prevents satisfactory diastolic filling. The distinction between constrictive pericarditis and other causes of heart failure, such as restrictive cardiomyopathy, is important because pericardiectomy can cure constrictive pericarditis
  • PMID 25072910
  • Constrictive pericarditis requiring pericardiectomy at Groote Schuur Hospital, Cape Town, South Africa: Causes and perioperative outcomes in the HIV era (1990-2012).
  • Mutyaba AK1, Balkaran S1, Cloete R1, du Plessis N1, Badri M2, Brink J3, Mayosi BM1.
  • The Journal of thoracic and cardiovascular surgery.J Thorac Cardiovasc Surg.2014 Aug 4. pii: S0022-5223(14)01038-1. doi: 10.1016/j.jtcvs.2014.07.065. [Epub ahead of print]
  • OBJECTIVE: The causes of constrictive pericarditis and predictors of perioperative outcome after pericardiectomy have not been clearly elucidated, especially in Africa, where the disease characteristics differ from those in developed countries. Furthermore, the effect of human immunodeficiency virus
  • PMID 25175954

和文文献

  • 収縮性心膜炎に対する心膜切除後に右室機能の改善に伴い左室拡張障害が顕在化した透析患者の麻酔管理経験
  • 森島 史織,酒井 宏明,岡崎 敦
  • 麻酔 63(2), 175-179, 2014-02
  • NAID 40019966062
  • Transient Constrictive Pericarditis Following Cardiac Surgery
  • Maeda Koichi,Saito Shunsuke,Toda Toru,Ueno Takayoshi,Kuratani Toru,Sawa Yoshiki
  • Annals of Thoracic and Cardiovascular Surgery, 2014
  • … Prior to performing a pericardiectomy, NSAID administration should be considered for affected patients who are hemodynamically stable. …
  • NAID 130003396745
  • Surgical experience with chronic constrictive pericarditis
  • Ariyoshi Tsuneo,Hashizume Koji,Taniguchi Shinichiro,Miura Takashi,Tanigawa Kazuyoshi,Matsukuma Seiji,Odate Tomohiro,Nakaji Shun,Sumi Mizuki,Eishi Kiyoyuki
  • General Thoracic and Cardiovascular Surgery 60(12), 796-802, 2012-12
  • … The purpose of this report is to review the outcome of pericardiectomy for constrictive pericarditis and to discuss its problems. … Methods: Sixteen consecutive patients who underwent pericardiectomy for constrictive pericarditis in our institution between March 2000 and June 2011 were reviewed. …
  • NAID 120005231062

関連リンク

Pericardiectomy is the surgical removal of part or most of the pericardium. This operation is most commonly done to relieve constrictive pericarditis, or to remove a pericardium that is calcified and fibrous. There are many etiologies for ...
What is pericardiectomy? Pericardiectomy is the surgical removal of a portion or all of the pericardium. It is also called pericardial stripping. The pericardium is a double-walled, membrane sac that surrounds the heart. It contains a ...

関連画像

however the pericardiectomy consisted only Pericardiectomy Definition. Crossword Pericardiectomy; PericardiotomyPericardiectomy pericardiectomy pericardial window stst chPericardiectomy; Pericardiotomy


★リンクテーブル★
先読み収縮性心膜炎
リンク元心膜切除術」「pericardiotomy」「心膜剥皮術」「心膜切除

収縮性心膜炎」

  [★]

constrictive pericarditis, CP
pericarditis constrictiva
収縮性心外膜炎
心膜炎

概念

  • 急性心膜炎のちに、心膜に線維性肥厚と癒着、あるいは石灰化を来し、心臓拡張期の血流充満が障害され、拍出量低下と右心系にのうっ滞を生じる
  • 肥厚した心膜が線維化・石灰化して慢性的に心臓を覆う状態が心膜癒着

病因

分類

  • 結核:最も多かった
  • 特発性
  • ウイルス性

病理

  • 心膜に石灰化が認められることが多い

症状

  • 脱力感、倦怠感、体重増加、腹囲の増加、腹部不快感、腹部の突出(protuberant abdomen)、浮腫 (HIM.1494)
  • (重症の症例)全身性浮腫、筋廃用、cachexia (HIM.1494)
  • 労作時呼吸困難。きざ呼吸もあり得るが、重度ではない (HIM.1494)

病態生理と症状

  • 静脈圧上昇 :肝うっ血、頚静脈怒張、浮腫
  • 肺静脈圧上昇:心不全(呼吸困難、起坐呼吸)

  • 心拍出量低下

身体所見

  • 脈:脈圧:正常 or 低下。1/3の症例で奇脈 (HIM.1494)
  • うっ血性肝腫大:腹水(浮腫より顕著)、黄疸 (HIM.1494)
  • 心尖拍動減弱、may retract in systole(Broadbent's sign)
  • 心膜ノック音 → 半数の症例で聴取?(QB.C-361) → 拡張早期過剰音/拡張早期過剰心音 と表現される

検査

  • 心カテーテル検査:右室圧曲線において、拡張期早期の急峻な圧低下とその後のプラトーが特徴的。dip and plateau pattern

治療

方針:症状が持続的/増悪傾向にあればpericardiectomyを行う。心膜の拘縮や一時的/可逆的である例も少数ながら存在するため、診断がついた患者であって慢性症状がなく、血行動態が安定していれば、手術を行う前に2-3ヶ月間保存的に経過を観察する。(参考1)
  • 対症療法
  • 利尿薬、塩分制限
  • 根治療法:心膜切除術
心拍数を下げる薬はよくない(カルシウム拮抗薬、β遮断薬)
  収縮性心膜炎 心タンポナーデ
奇脈 + +++
クスマウル徴候 +++ -
  • In constrictive pericarditis, the negative intrathoracic pressure generated by inspiration is not easily transmitted through the rigid pericardial shell to the right-sided heart chambers; therefore, inspiratory augmentation of RV filling is more limited.
  • 収縮性心膜炎では胸腔内圧の陰圧に心臓が影響されにくい。このために静脈還流量の変動は少なく、呼吸によらず頚静脈が怒張する? 左室への血流量も呼吸の影響を受けにくいために奇脈は心タンポナーデと比べて見られる頻度は低い?

参考

  • 1. [charged] Constrictive pericarditis - uptodate [1]




心膜切除術」

  [★]

pericardiectomy, endocardial resection procedure
心嚢切除術
心膜切開心膜切除心膜剥皮術



pericardiotomy」

  [★]

  • 心膜切開、心膜切開術
pericardiectomypericardiocentesis


心膜剥皮術」

  [★]

pericardiectomy
心膜切除術
心膜切開術


心膜切除」

  [★]

pericardiectomy
心膜切除術




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