Abstract
Between 1973 and 1975, 19 patients were treated for uremic pericarditis. The clinical presentation of the condition varied, with some patients having minimal symptoms (chest pain, fever) and others sustaining circulatory collapse. Pericardial friction rub, elevated central venous pressure, and paradoxical pulse were the most common physical findings. Serial chest radiography, echocardiography, and cardiac scan were most useful in establishing the diagnosis. Three patients had cardiac catheterization and angiography. Pericardiectomy was the initial procedure performed in 13 of 19 patients, and there was no operative mortality or recurrence of pericarditis. Four patients initially had a pericardial window created rather than a pericardiectomy. Two had recurrence of symptoms and one required later total pericardiectomy. Two patients underwent initial tube pericardiostomy. Both died after recurrent tamponade. Total pericardiectomy appears to be the treatment of choice for uremic pericarditis and the only form of therapy which is definitive. The risk of circulatory collapse from tamponade warrants early operative intervention in this critically ill group of patients.
Résumé
De 1973 à 1975, 19 patients ont été traités pour péricardite urémique. Les malades présentaient un tableau clinique très variable, certains avaient peu de symptômes (douleurs thoraciques, température) et d'autres étaient en collapsus. Les signes physiques les plus fréquents furent le frottement péricardique, l'élévation de la pression veineuse centrale et le pouls paradoxal. Les examens les plus utiles pour l'établissement du diagnostic sont la radiographie de thorax, l'échographie et la scintigraphie cardiaque. Trois patients ont subi un cathétérisme cardiaque et une angiographie. Treize malades sur 19 ont subi d'emblée une péricardectomie sans mortalité opératoire ni récidive de la péricardite. Chez 4 patients, une fenêtre antérieure a été créée dans le péricarde, les symptômes sont réapparus chez 2 malades et l'un d'eux dut subir une péricardectomie. Un simple drainage a été réalisé chez 2 patients qui succombèrent à une récidive de la tamponade cardiaque. La péricardectomie totale semble être l'intervention de choix de la péricardite urémique car elle seule réalise un traitement définitif de cette affection. Le risque de tamponade cardiaque justifie un traitement chirurgical précoce dans ce groupe de malades graves.
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References
Bailey, G.L., Hampers, C.L., Hager, E.B., Merrill, J.P.: Uremic pericarditis. Clinical features and management. Circulation38:582, 1968
Beaudry, C., Nakamoto, S., Kolff, W.J.: Uremic pericarditis and cardiac tamponade in chronic renal failure. Ann. Intern. Med.64:990, 1966
Mitchell, A.G.: Pericarditis during chronic haemodialysis therapy. Postgrad. Med. J.50:741, 1974
Collins, H.A., Killen, D.A., Gobbel, W.G., Jr., Ginn, H.E.: Pericardiectomy for uremic pericardial tamponade. Ann. Thorac. Surg.9:327, 1970
Compty, C.M., Cohen, S.L., Shapiro, F.L.: Pericarditis in chronic uremia and its sequels. Ann. Intern. Med.75:173, 1971
Wray, T.M., Humphreys, J., Perry, J.M., Stone, W.J., Bender, H.W., Jr.: Pericardiectomy for treatment of uremic pericarditis. Circulation50 [Suppl.2]:268, 1974
Ali-Regiaba, S., White, R.P., Gay, W.A., Stenzel, K.H., Sullivan, J.F., Riggio, R.R., Tapia, L., Cheigh, J.S., David, D.S., Rubin, A.L.: Treatment of uremic pericarditis by anterior pericardiectomy. Lancet2:12, 1974
Morin, J.E., Mulder, D.S., Long, R.: Pericardiectomy for uremic tamponade. Can. J. Surg.19:109, 1976
Luft, F.C., Kleit, S.A., Smith, R.N., Glover, J.L., Carr, J.B., de Quesada, A.M.: Management of uremic pericarditis with tamponade. Arch. Intern. Med.134:488, 1974
Hager, E.B.: Clinical observations of five patients with uremic pericardial tamponade. N. Engl. J. Med.273:304, 1965
Ghavamian, M., Gutch, C.F., Hughes, R.K., Kopp, K.F., Kolff, W.J.: Pericardial tamponade in chronichemodialysis patients. Arch. Intern. Med.131:249, 1973
Marini, P.V., Hull, A.R.: Uremic pericarditis: A review of incidence and management. Kidney Int.7 [Suppl. 2]:163, 1975
Buselmeir, T.J., Simmons, R.L., von Hartitzsch, B., et al.: Persistent uremic pericardial effusion: Pericardial drainage and localized steroid instillation as definitive therapy. In Proceedings of the American Society of Nephrology, Washington, D.C., Nov. 19–20, 1973. Washington, D.C., American Society of Nephrology, 1973
Eliasson, G., Murphy, J.F.: Steroid therapy in uremic pericarditis. Report of three cases. J.A.M.A.229:1634, 1974
Minuth, A.N.W., Notlebohm, G.A., Eknoyan, G., Suki, W.N.: Indomethacin treatment of pericarditis in chronic hemodialysis patients. Arch. Intern. Med.135:807, 1975
Buja, L.M., Friedman, C.A., Roberts, W.C.: Hemorrhagic pericarditis in uremia. Arch. Pathol.90:325, 1970
Singh, S., Newmark, K., Ishikawa, I., Mitra, S., Berman, L.B.: Pericardiectomy in uremia: The treatment of choice for cardiac tamponade in chronic renal failure. J.A.M.A.228:1132, 1974
Connors, J.P., Kleiger, R.E., Shaw, R.C., et al.: The indications for pericardiectomy in the uremic pericardial effusion. Surgery (in press)
Pillay, V.K.G., Sarpel, S.C., Kurtzman, N.A.: Subacute constrictive uremic pericarditis. J.A.M.A.235:1351, 1976
Wolfe, S.A., Bailey, G.F., Collins, J.J., Jr.: Constrictive pericarditis following uremic effusion. J. Thorac. Cardiovasc. Surg.63:540, 1972
Sloan, A.M.: Uremic constrictive pericarditis. Med. Ann. D.C.43:1, 1974
Reyman, T.A.: Subacute constrictive uremic pericarditis. Am. J. Med.46:972, 1969
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Engelman, R.M., Levitsky, S., Konchigeri, H.N. et al. Total pericardiectomy for uremic pericarditis. World J. Surg. 1, 769–774 (1977). https://doi.org/10.1007/BF01555936
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DOI: https://doi.org/10.1007/BF01555936