title: Pericardiectomy in children <15 years of age.
abstract: Between January, 2002 and December, 2011, 27 patients (19 boys) underwent pericardiectomy. The mean age was 9.3 ± 4.96 years (range 0.4 to 15 years) and the mean duration of symptoms was 16.9 ± 22.15 months. In all, 25 patients had dyspnoea; eight were in New York Heart Association (NYHA) class IV; six had bacterial pericarditis; and 18 were on anti-tuberculosis treatment, although only nine had records suggesting tuberculosis. There were nine patients who underwent pre-operative pigtail catheter drainage of pericardial fluid. Surgical procedures were complete pericardiectomy (n = 20), partial pericardiectomy (n = 6), and pleuropericardial window (n = 1).The mean pre-operative right atrial pressure was 20.4 ± 4.93 mmHg. There were six hospital deaths due to low cardiac output (n = 5) and arrhythmia (n = 1). The mean intensive care unit stay was 2.7 ± 1.2 days and mean post-operative stay was 9.9 days. The mean right atrial pressure dropped to 8.7 ± 1.15 mmHg. Adverse outcomes defined as death/prolonged intensive care unit stay, prolonged post-operative stay were not associated with sex, diagnosis of tuberculosis or pyopericardium, or the duration of symptoms or pre-operative right atrial pressure. Younger patients had prolonged intensive care unit stay (p = 0.03) but not increased mortality. Advanced NYHA class predicted death (p = 0.02). The mean follow-up was 23.1 ± 23.8 months. All except one survivor are in NYHA class I and off all cardiac medications. Despite adequate surgery, pericardiectomy in children is associated with a high mortality, which is related to delayed surgery and poor pre-operative general condition. No specific pre-operative variable other than worse pre-operative NYHA class is a predictor of survival. Therefore, early pericardiectomy should be undertaken in such patients.
authors.affiliation: Cardiothoracic Center and Department of Biostatistics,All India Institute of Medical Sciences,New Delhi,India.
authors.forename: Sachin
authors.initials: S
authors.lastname: Talwar
authors.affiliation: Cardiothoracic Center and Department of Biostatistics,All India Institute of Medical Sciences,New Delhi,India.
authors.forename: Vinitha Viswambharan
authors.initials: VV
authors.lastname: Nair
authors.affiliation: Cardiothoracic Center and Department of Biostatistics,All India Institute of Medical Sciences,New Delhi,India.
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Choudhary
authors.affiliation: Cardiothoracic Center and Department of Biostatistics,All India Institute of Medical Sciences,New Delhi,India.
authors.forename: Vishnubhatla
authors.initials: V
authors.lastname: Sreeniwas
authors.affiliation: Cardiothoracic Center and Department of Biostatistics,All India Institute of Medical Sciences,New Delhi,India.
authors.forename: Anita
authors.initials: A
authors.lastname: Saxena
authors.affiliation: Cardiothoracic Center and Department of Biostatistics,All India Institute of Medical Sciences,New Delhi,India.
authors.forename: Rajnish
authors.initials: R
authors.lastname: Juneja
authors.affiliation: Cardiothoracic Center and Department of Biostatistics,All India Institute of Medical Sciences,New Delhi,India.
authors.forename: Shyam Sunder
authors.initials: SS
authors.lastname: Kothari
authors.affiliation: Cardiothoracic Center and Department of Biostatistics,All India Institute of Medical Sciences,New Delhi,India.
authors.forename: Balram
authors.initials: B
authors.lastname: Airan
mesh_terms: D000293:Adolescent; D001424:Bacterial Infections / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D010492:Pericardiectomy / Q000379:methods*; D010493:Pericarditis / Q000601:surgery; D010494:Pericarditis, Constrictive / Q000601:surgery*; D010495:Pericarditis, Tuberculous / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D061665:Time-to-Treatment