Severe calcific constrictive pericardiectomy operation: ‘Hearts of stone’

Background: Dense constrictive pericarditis, ‘Hearts of stone’ is a rare condition characterized by limitation of myocardium due to a massive fibrosis and calcification of the pericardium. The aim of this study was to research the literature to discuss the surgical intervention and management of densely calcified constrictive pericarditis. Methods: Over a seven-year period, 19 consecutive patients who underwent pericardiectomy operation for severe constrictive pericarditis reviewed to determine reasons, surgical techniques, mortality and morbidity rates, and improvement of functional capacity. We freed the anterior pericardium from phrenic nerve to phrenic nerve. In two cases, we used a rongeur to break down the dense calcification. The indications for pericardiectomy were tuberculous in 4 cases (21%), idiopathic-fibrous in 11(57.8%), rheumatic in 2(10.5%), uremic in 1(5.2%), and neoplastic in 1(5.2%). Results: Inpatients mortality ratio was 5.2% in case of isolated severe calcified pericardiectomy. Ascites in 3 patients (15.7%), hepatomegaly in 4 (21%) and peripheral edema in 15 (78.9%) were found on their physical examination. In the 1st postoperative month follow up, dramatically improvement of preoperatively functional capacity were the number of cases in New York Heart Association class IV (worse general condition) moved from 14 to II; in class III from 4 to II; in class II from to I in one case. In our all series, idiopathic-fibrous was the most frequent cause of chronic severe constrictive pericarditis, but the second most common tuberculous pericarditis was increasing overall. Postoperative and neoplastic pericarditis were rare. Conclusion: The preoperative clinical conditions and functional status at follow-up was improved in all cases. We recommended that the orthopedic surgical instrument, ‘rongeur’, is very useful to cut that totally calcified tissue.