title: Serial semi-invasive hemodynamic assessment following pericardiectomy for chronic constrictive pericarditis.
abstract: OBJECTIVE
  This study was designed to prospectively investigate the effects of pericardiectomy via median sternotomy on intra- and postoperative hemodynamics by a new semi-invasive device (Flotrac/VigileoTM monitor) using arterial pressure waveform analysis.
  
  
  METHODS
  Thirty consecutive patients aged 15 to 55 years (mean+SD, 31.73 + 13.53 years), who had undergone total pericardiectomy via median sternotomy underwent serial hemodynamic evaluation. FlotracTM Sensor - derived stroke volume, stroke volume variation, systemic vascular resistance index (SVRI), cardiac index and right atrial pressure were measured just before and after pericardiectomy, at 12 hours, 24 hours, 48 hours, 72 hours and at discharge postoperatively.
  
  
  RESULTS
  Majority of patients (73.33%) exhibited statistically significant reduction of right atrial pressure and SVRI along with improvement in cardiac index and oxygen delivery in the immediate and late postoperative period. However, the stroke volume and stroke volume variation did not increase proportionately on completion of surgery. Patients with low cardiac output syndrome exhibited persistently high central venous pressure with reduced cardiac index and echocardiographically abnormal diastolic filling characteristics.
  
  
  CONCLUSIONS
  We conclude that there is early normalization of hemodynamics following pericardiectomy via median sternotomy and the adequacy of pericardiectomy can be accurately assessed by the new semi-invasive arterial pressure waveform analysis device. Stroke volume variation is a non-predictor of fluid requirement during and after pericardiectomy.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ujjwal Kumar
authors.initials: UK
authors.lastname: Chowdhury
authors.affiliation: Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Poonam Malhotra
authors.initials: PM
authors.lastname: Kapoor
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Adil
authors.initials: A
authors.lastname: Rizvi
authors.affiliation: Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Vishwas
authors.initials: V
authors.lastname: Malik
authors.affiliation: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Seth
authors.affiliation: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Narang
authors.affiliation: Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Mani
authors.initials: M
authors.lastname: Kalaivani
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sarvesh Pal
authors.initials: SP
authors.lastname: Singh
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sathiya
authors.initials: S
authors.lastname: Selvam
mesh_terms: D000293:Adolescent; D000328:Adult; D062185:Atrial Pressure / Q000502:physiology; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D010492:Pericardiectomy; D010494:Pericarditis, Constrictive / Q000601:surgery*; D011184:Postoperative Period; D011446:Prospective Studies; D015203:Reproducibility of Results; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000502:physiology; D055815:Young Adult