O presente trabalho avaliou corações com pericardite e pulmões correspondentes através da análise anatomopatológica, bacteriológica, histopatológica e da técnica da Reação em Cadeia da Polimerase (PCR) a fim de identificar os agentes envolvidos no processo e correlacioná-los com as lesões macroscópicas presentes. O estudo foi realizado em quatro frigoríficos do estado do Rio Grande do Sul com o apoio do Serviço de Inspeção Federal (SIF) durante o período de fevereiro a outubro de 2010. Foram coletadas 120 amostras de corações com pericardite e pulmões correspondentes e avaliadas 3.487 carcaças na linha de inspeção em 20 lotes diferentes, totalizando 8 coletas. Os materiais foram examinados nos laboratórios de Microbiologia, Biologia Molecular e Patologia Veterinária da Faculdade de Veterinária da Universidade Federal do Rio Grande do Sul. Entre as pericardites, 86,7% foram classificadas como fibrinosas (104/120), 6,7% serosas (8/120), 2,5% (3/120) sero-fibrinosas e 4,2% (5/120) amostras não puderam ser classificadas. Foram diagnosticadas lesões de endocardite em somente 2,5% (3/120) dos corações. Quanto aos pulmões analisados, as alterações macroscópicas mais encontradas foram 66,6% (80/120) aderências de pleura direita e/ou esquerda, 19,1% (23/120) hepatizações dos lobos apicais direito e 5,83% (7/120) do esquerdo, 23,33% (28/120) do lobo cardíaco direito e 23,33% (28/120) do esquerdo. Pela análise histopatológica do coração, a lesão mais frequente foi presença de tecido de granulação denso fibroso e em algumas amostras tecidos de granulação frouxo, com proliferação de vasos em ambos os casos. Havia presença de fibrina e células inflamatórias mononucleares em alguns casos. Na análise dos pulmões correspondentes, 70% (84/120) das amostras de pulmões apresentavam algum tipo de lesão aparente. As lesões mais comuns foram pleurite crônica, hiperplasia das células do tecido linfóide associado aos brônquios (BALT), presença de macrófagos alveolares e broncopneumonia purulenta. Não foram observadas lesões microscópicas em 23,3% (28/120) dos pulmões e 6,6% (8/120) não foram coletados para análise devido a cronicidade da lesão. A análise da carcaça mostrou pleurite parietal em 12,5% (15/120) e algum tipo de envolvimento articular em 1,6 % (2/120) dos animais, não sendo objetivo avaliar o tipo de lesão e sim uma possível correlação com Haemophilus parasuis. Das análises bacteriológicas dos corações, obteve-se um maior número de isolados de Pasteurella multocida 16% (20/120), seguido de Streptococcus spp. 17,3% (6 /120) e 5% (6/120) Haemophilus parasuis. A maior parte dos isolados foi obtida das pericardites fibrinosas. Com relação aos pulmões correspondentes, foram isolados 17,5% (22/120) Pasteurella multocida, 51.57% (8/120) Streptococcus spp., e 0,8% (1/120) Haemophilus parasuis. Entre os isolados de P. multocida foi realizada a tipificação capsular das cepas identificadas no pulmão e coração através da PCR e todas pertenciam ao tipo A. Na técnica da PCR no coração pode-se observar um grande número de M. hyopneumoniae 34,8% (39/112), seguido de A. pleuropneumoniae 23,2% (26/112), H. parasuis 6,2% (7/112), P. multocida tipo A 3,5% (4 /112) e M. hyorhinis 2,6% (3/112). A mesma técnica aplicada aos pulmões correspondentes, revelou M. hyopneumoniae 81,2% (91 /112), H. parasuis 36,6 % (41 /112), A. pleuropneumoniae 33,9% (38/112), P. multocida tipo A 30,3% (34/112), M. hyorhinis 9.8% (11/112). / The present work assessed hearts with pericarditis and the corresponding lungs through visual analysis of gross lesions, bacteriology, histopathology and polymerase chain reaction (PCR) to identify agents involved in the processes and to correlate them with the lesions. The study was carried out in four slaughterhouses from the state of Rio Grande do Sul, Brazil, with the help of the Service of Federal Inspection (SIF) during the period of February to October, 2010. Samples of 120 hearts with pericarditis and corresponding lungs were collected and examined, and 3.487 carcasses were assessed in the slaughter line in 20 different batches, in a total of 8 sample collections. Materials were examined in the laboratories of Microbiology, Molecular Biology and Pathology of the Faculdade de Veterinária da Universidade Federal do Rio Grande do Sul, Brazil. Among the samples with pericarditis, 104 were classified as fibrinous (86.7%), 8 serous (6.7%), 3 sero-fibrinous (2.5%) and 5 remained unclassified (4.2%). Lesions of endocarditis were present in 3 hearts (2.5%). Regarding lungs, the commonest gross changes were 80 pleural adhesions (66.6%) and 23 consolidations of the right apical lobes of the lung (19.1%) and 7 (5,83%) of the left; 28 (23,33%) from right cardiac lobe and 28 (23,33%) of left. Using histopathological analysis of the heart, the most frequent lesions were the presence of dense fibrous granulomatous tissue and, in some samples, loose granulation tissue, with of vessels proliferation in both cases. It was also found fibrin and inflammatory mononuclear cells in some cases. In the analysis of the corresponding lungs, 84 (70%) of the samples showed some type of apparent lesion. Te most prevalent lesions were chronic pleuritis, hyperplasia of lymphoid tissue cells associated to bronchia (BALT), presence of lung macrophages and purulent bronchopneumonia. Twenty eight lungs (23.3%) did not show any microscopic lesion and 8 (6.6%) were not collected because of the chronicity of the lesion. The analysis of the carcass showed parietal pleurisy in 15 (12.5 %) and joint involvement in 2 (1.6 %), but the present study did not intend to assess such lesions but a possible correlation with Haemophilus parasuis infection. Regarding bacteriological examination of the heart, Pasteurella multocida was the biggest isolation rate 16% (20/120), followed by Streptococcus spp 17.3% (6 /120) and 5% (6/120) Haemophilus parasuis. Most isolates were obtained from fibrinous pericarditis. Regarding the corresponding lungs, Pasteurella multocida was isolated in 17.5% (22/120) materials, Streptococcus spp in 51.57% (8/120), and Haemophilus parasuis in 0.8% (1/120). Pasteurella multocida capsular typing was carried out from strains identified through PCR from heart and lungs, all belonged to the serotype A. By PCR from samples from pericarditis a large number of M. hyopneumoniae was detected: 34. 8% (39/112), followed by APP 23.2% (26/112), H. parasuis 6.2% (7/112), P. multocida type A 3.5% (4 /112) and M. hyorhinis 2.6% (3/112). The same technique applied to the corresponding lungs, showed M. hyopneumoniae in 81.2% (91 /112), H. parasuis in 36.6 % (41 /112), APP in 33.9% (38/112), P. multocida type A in 30.3% (34/112) and M. hyorhinis in 9.8% (11/112).

Constrictive pericarditis (CP) is an uncommon disease with multiple causes and discrepant clinical outcome. Till date, there is a scarcity of publications, clearly defining the risk factors of poor outcomes after surgery for CP. Therefore, we retrospectively analysed the results of the surgical treatment for CP at our institution to define the risk factors of poor outcomes. A total of 97 patients (65 male, 67%) undergoing surgery for CP at our institution from 1995 to 2012 were included in this study. CP was diagnosed either preoperatively by cardiac catheterization or at surgery. The mean age was 60±12.5 years and the primary etiology was idiopathic in more than halt the cases, followed by prior cardiac surgery, post-irradiation, and miscellaneous. Preoperative and intraoperative risk factors for 30-day and late mortality were analyzed using stepwise multivariate logistic and Cox regression analysis respectively. Long-term survival was determined by the Kaplan-Meier curve. Mean follow-up was 2.9±3.8 years (range: 0.1-14 years). All patients received either radical (53 patients, 55.2%) or partial (44 patients, 44.8%) pericardiectomy. Concomitant procedures were performed in 38 (39,2%) patients. Overall 30-day, 1-year and 5-year survival were 66.8 %, 58.1% and 52.6% respectively, without significant difference according to the underlying etiology. Univariate analysis showed that preoperative renal dysfunction, liver failure, respiratory insufficiency, emergency surgery and longer operating times were associated with significantly higher 30-day mortality. Multivariate analysis revealed patients with concomitant coronary artery disease to be at higher risk of poor immediate survival, whereas a higher glomerular filtration rate GFR (ml/min/1,73m2) was protective for early mortality. Long-term mortality was independently predicted by the presence of a coronary artery disease, a COPD (chronic obstructive pulmonary disease) and higher absolute creatinine value. To conclude, surgery for constrictive pericarditis is associated with a relatively poor prognosis. Reduced left ventricular ejection fraction and right ventricular dilatation were independent predictors for early mortality, while coronary artery disease, chronic obstructive pulmonary disease, and renal insufficiency were risk factors for late mortality. Thus, indication for surgery needs to be determined on an individual basis and should be justified by an otherwise worse natural prognosis.:1 CONTENTS 1 CONTENTS I 2 ABBREVIATIONS III 3 BIBLIOGRAPHIC DESCRIPTION 1 3.1 REVIEW 1 4 INTRODUCTION 3 4.1 CHRONIC CONSTRICTIVE PERICARDITIS 3 4.2 HISTORY 6 4.3 DEFINITION 8 4.3.1 ACUTE PERICARDITIS 8 4.3.2 RECURRENT PERICARDITIS 9 4.3.3 PERICARDIAL EFFUSION, PERICARDIAL TAMPONADE, EFFUSIVE-CONSTRICTIVE PERICARDITIS 10 4.3.4 CHRONIC PERICARDITIS 12 4.3.5 CHRONIC CONSTRICTIVE PERICARDITIS 14 4.3.6 CLINICAL PRESENTATION 16 4.3.7 DIAGNOSTIC APPROACH 18 4.3.8 TREATMENT OPTIONS 23 4.3.9 PERICARDIECTOMY 24 5 AIM OF THE STUDY 29 6 MATERIAL AND METHODS 30 6.1 DATA COLLECTION 30 6.2 DIAGNOSIS OF CONSTRICTIVE PERICARDITIS 31 6.3 OPERATIVE PROCEDURES 31 6.4 OPERATIVE TECHNIQUE 32 6.5 POSTOPERATIVE COURSE 33 6.6 INCLUSION CRITERIA 34 6.7 EXCLUSION CRITERIA 34 6.8 FOLLOW UP 34 6.9 STATISTICS 35 6.10 STATISTICAL MODEL 37 7 RESULTS 39 7.1 PREOPERATIVE CHARACTERISTICS 39 7.2 ETIOLOGY 42 7.2.1 INDEPENDENT PREDICTORS FOR ALL-CAUSE EARLY MORTALITY 44 7.2.2 INDEPENDENT PREDICTORS FOR ALL-CAUSE LONG-TERM MORTALITY 44 7.3 MORTALITY 46 7.3.1 ALL-CAUSE MORTALITY 46 7.3.2 SURVIVAL ACCORDING TO ETIOLOGY 47 7.3.3 LATE SURVIVAL WITHOUT PERIOPERATIVE DEATHS 48 7.3.4 ISOLATED PERICARDIECTOMY VS. CONCOMITANT SURGERY 49 7.3.5 POSTOPERATIVE OUTCOMES: 50 7.3.6 RECEIVER OPERATING CHARACTERISTIC (ROC) CURVE 51 8 DISCUSSION 54 8.1.1 PERSONAL THOUGHTS AND FUTURE DIRECTIONS 58 9 LIMITATIONS 61 10 CONCLUSION 62 11 SUMMARY 63 12 REFERENCES 65 13 ATTACHMENTS 70 13.1 DIAGNOSTIC APPROACH IN CONSTRICTIVE PERICARDITIS 70 13.2 FOLLOW-UP QUESTIONNAIRE 72 14 NOTE OF THANKS 80 15 DANKSAGUNG 81 16 ERKLÄRUNG ÜBER DIE EIGENSTÄNDIGE ABFASSUNG DER ARBEIT 82 17 CURRICULUM VITAE 83

We are reporting an unusual case of cat-scratch disease in a young adolescent girl presenting with recurrent ascites. The illness started with nonspecific symptoms followed by ascites and an axillary lymph node enlargement. She had recurrent ascites for 18 months associated with constrictive pericarditis. Following pericardiectomy, she had a resolution of ascites and was back to her normal life. This is a first documented report of a constrictive pericarditis following cat scratch diseases in English literature.

Introduction: Globally, one in four persons infected with the human immunodeficiency virus (HIV) who are living with the acquired immunodeficiency syndrome (AIDS) will die of tuberculosis (TB). The estimated number of HIV-infected children who die of tuberculosis, especially extrapulmonary TB (EPTB), in Haiti, is only loosely based on facts or investigation. This study proposes to describe demographics of children with EPTB in a pediatric TB hospital in Haiti. The objectives are two-fold. The first objective is to describe the population of children discharged from Grace Children's Hospital with a confirmed diagnosis of tuberculosis overall, and broken down by whether or not the child had an extrapulmonary manifestation of the TB disease. Specifically, we describe the demographic characteristics and the prevalence of HIV and other co-morbidities of the children, in-hospital mortality, and the diagnostic tools used to determine TB infection including the sputum test, and th e documentation of family members also infected. As part of the descriptive process, by examining those with only pulmonary TB (PTB) and EPTB separately, we investigate if they appear to be different sub-populations based on demographic characteristics and clinical measures. The second objective of this work is to determine if there is a positive association between HIV infection and the EPTB manifestation in children with a confirmed diagnosis of TB, both crudely and after adjusting for demographic variables and co-morbidities. Methods: A cross-sectional study design was used to review medical charts of clinically diagnosed pediatric TB cases for a five-year period (January 1, 1999 -- December 31, 2003). This included 492 pulmonary TB and 210 extrapulmonary TB cases. Variables measured included clinical measures and demographic characteristics. Results: Data for 615 hospitalized, clinically diagnosed pediatric TB cases were reviewed. There were 315 (51.4%) males and 298 (48.6%) females with a mean age of 5.40 years (range 0.17 - 14 years), with 214 (37.9%) of the patients aged 0-2 years. Percent males were 47.8% and 57.9% in PTB and EPTB groups respectively (p<0.05). One hundred and seven (17.4%) of patients were HIV positive. Three hundred eighty-eight (63%) of the patients had one or more additional co-morbidities: [anemia 299 (48.6%), intestinal parasites 93 (15.1%), malaria 58 (9.4%) and gastroenteritis 19 (3.1%)]. Nearly 85% of the children were undernourished. Eighty-three child patients (13.5%) died in the hospital. Children with EPTB were much more likely to be over the age of two (74% vs. 56% in PTB group), resulting in a highly significant Chi-square stati stic. The overall difference in mean age, however, was only borderline significant with children with EPTB being slightly older [p=0.059] and age was only weakly associated with TB group. They were much less likely to be HIV positive (8.6% vs. 22%, p<0.01). Children in the EPTB group were somewhat less likely to die in the hospital (10.0% vs. 15.4%, p=0.066). The OR was greater than 4 for HIV and was greater than 2 for poor nutrition status [p<0.01 for each]. Conclusion: There was no association in this model between EPTB and mortality. The apparent univariate association between EPTB and reduced mortality can be explained by lower prevalence of HIV and poor nutrition status in this sub-sample. This study has implications for hospital-based pediatric TB diagnosis and epidemiology in resource-poor countries.

Introdução: A pericardiectomia é o tratamento de escolha para pacientes com pericardite constritiva crônica sintomática, entretanto, o impacto do procedimento na capacidade cardiopulmonar e fisiologia cardiorrespiratória durante a vigília e sono é pouco estudado. Objetivo: Avaliar o impacto da cirurgia de pericardiectomia sobre a capacidade funcional de pacientes com pericardite constritiva crônica sintomática. Métodos: Trata-se de estudo observacional prospectivo com 25 pacientes consecutivos com diagnóstico de pericardite constritiva crônica submetidos à pericardiectomia. Foram realizados os seguintes procedimentos uma semana antes e seis meses após a pericardiectomia: avaliação clínica e antropométrica, avaliação da qualidade de vida e do sono, dosagem dos níveis séricos de BNP, ecocardiograma transtorácico, teste cardiopulmonar de esforço, polissonografia noturna completa. Resultados: A idade média foi 45 anos, com predomínio do sexo masculino (76%). A etiologia foi principalmente idiopática (76%), seguida por tuberculose (12%). O ecocardiograma revelou fração de ejeção do ventrículo esquerdo preservada e dilatação de veia cava inferior (92%) na maioria dos pacientes. Todos os pacientes foram submetidos à pericardiectomia de frênico a frênico via esternotomia mediana, sem circulação extracorpórea. Após a pericardiectomia, houve redução da: classe funcional III/IV (56% vs. 8%, p < 0,001), ascite (72% vs. 12%, p < 0,001) e edema de membros inferiores (88% vs. 24%, p < 0,001) em relação ao pré-operatório. O teste cardiopulmonar revelou melhora do VO2 pico (18,7 ± 5,6 vs. 25,2 ± 6,3 mL/kg/min, p < 0,001), limiar anaeróbico (13,1 ± 3 vs. 17,7 ± 5,5 mL/kg/min, p < 0,001) e velocidade na esteira rolante de 2,5 (2-2,5) para 3 (2,5-3,3) mph, p=0,001. Na análise multivariada, a idade foi o único preditor independente da variação de VO2 (r=-0,658, p=0,003). Os níveis séricos de BNP apresentaram redução significativa de 143 (83,5-209,5) pg/mL para 76 (40-117,5) pg/mL, p=0,011. A polissonografia noturna completa no pré-operatório demonstrou a presença de apneia do sono moderada/ grave (IAH >= 15 eventos/hora) em 13 pacientes, com predomínio de hipopneias. Não houve mudança significativa do índice de apneia-hipopneia após a pericardiectomia: IAH pré 15,6 (8,3-31,7) vs. IAH pós 14,6 (5,75-29,9), p=0,253; entretanto, houve melhora da qualidade do sono (Pittsburgh pré 7,8 ± 4,10 vs. Pittsburgh pós 4,7 ± 3,7, p < 0,001). O IAH apresentou correlação positiva com os níveis de BNP (r=0,418, p=0,037) e EuroSCORE (r=0,480, p=0,015) no pré-operatório. Conclusão: Pacientes com pericardite constritiva crônica sintomática apresentaram, seis meses após a cirurgia de pericardiectomia, melhora da capacidade cardiopulmonar, da classe funcional e da qualidade de vida. A apneia do sono se mostrou frequente e apresentou correlação com níveis séricos de BNP e EuroSCORE no pré-operatório. O índice de apneia-hipopneia não apresentou mudanças significativas após a pericardiectomia. A despeito disso, houve melhora da qualidade do sono / Introduction: Pericardiectomy is the treatment of choice for patients with symptomatic chronic constrictive pericarditis; however, the impact of the procedure on cardiopulmonary capacity and cardiorespiratory physiology during wakefulness and sleep has been poorly studied so far. Objective: To evaluate the impact of pericardiectomy surgery on functional capacity of patients with symptomatic chronic constrictive pericarditis. Methods: This is a prospective observational study with 25 consecutive patients diagnosed with chronic constrictive pericarditis submitted to pericardiectomy. The following procedures were performed one week before and six months after pericardiectomy: clinical and anthropometric evaluation, quality of life and sleep evaluation, serum BNP levels, transthoracic echocardiography, cardiopulmonary exercise test, complete nocturnal polysomnography. Results: The mean age was 45, with a predominance of males (76%). The etiology was mainly idiopathic (76%), followed by tuberculosis (12%). The echocardiogram revealed preserved left ventricular ejection fraction and inferior vena cava dilatation (92%) in most patients. All patients underwent phrenic to phrenic pericardiectomy via median sternotomy, without extracorporeal circulation. After pericardiectomy there was a reduction in: functional class III / IV (56% vs. 8%, p < 0.001), ascites (72% vs. 12%, p < 0.001) and lower limb edema (88% vs. 24%, p < 0.001) as compared to the preoperative period. The cardiopulmonary test revealed improvement in VO2 peak (18.7 ± 5.6 vs. 25.2 ± 6.3 mL/kg/min, p < 0.001), anaerobic threshold (13.1 ± 3 vs. 17.7 ± 5.5 mL/kg/min, p < 0.001) and velocity on the treadmill from 2.5 (2-2.5) to 3 (2.5-3.3) mph, p=0.001. In multivariate analysis, age was the only independent predictor of VO2 variation (r = -0.658, p = 0.003). Serum BNP levels showed a significant reduction from 143 (83.5-209.5) pg/mL to 76 (40-117.5) pg/mL, p=0.011. The complete nocturnal polysomnography in the preoperative period showed moderate / severe sleep apnea (AHI >= 15 events / hour) in 13 patients, predominantly hypopnea. There was no significant change in apnea-hypopnea index after pericardiectomy: AHI pre 15.6 (8.3-31.7) vs. AHI post 14.6 (5.75-29.9), p= 0.253; however, there was improvement in sleep quality (Pittsburgh pre 7.8 ± 4.10 vs. Pittsburgh post 4.7 ± 3.7, p < 0.001). AHI presented a positive correlation with BNP levels (r=0.418, p=0.037) and EuroSCORE (r=0.480; p=0.015) in the preoperative period. Conclusion: Patients with symptomatic chronic constrictive pericarditis showed improvement in cardiopulmonary capacity, functional class and quality of life six months after pericardiectomy. Sleep apnea was frequent and correlated with serum levels of BNP and EuroSCORE in the preoperative period. The apnea-hypopnea index did not show significant changes after pericardiectomy. Nevertheless, there was an improvement in sleep quality

Introdução: A pericardiectomia é o tratamento de escolha para pacientes com pericardite constritiva crônica sintomática, entretanto, o impacto do procedimento na capacidade cardiopulmonar e fisiologia cardiorrespiratória durante a vigília e sono é pouco estudado. Objetivo: Avaliar o impacto da cirurgia de pericardiectomia sobre a capacidade funcional de pacientes com pericardite constritiva crônica sintomática. Métodos: Trata-se de estudo observacional prospectivo com 25 pacientes consecutivos com diagnóstico de pericardite constritiva crônica submetidos à pericardiectomia. Foram realizados os seguintes procedimentos uma semana antes e seis meses após a pericardiectomia: avaliação clínica e antropométrica, avaliação da qualidade de vida e do sono, dosagem dos níveis séricos de BNP, ecocardiograma transtorácico, teste cardiopulmonar de esforço, polissonografia noturna completa. Resultados: A idade média foi 45 anos, com predomínio do sexo masculino (76%). A etiologia foi principalmente idiopática (76%), seguida por tuberculose (12%). O ecocardiograma revelou fração de ejeção do ventrículo esquerdo preservada e dilatação de veia cava inferior (92%) na maioria dos pacientes. Todos os pacientes foram submetidos à pericardiectomia de frênico a frênico via esternotomia mediana, sem circulação extracorpórea. Após a pericardiectomia, houve redução da: classe funcional III/IV (56% vs. 8%, p < 0,001), ascite (72% vs. 12%, p < 0,001) e edema de membros inferiores (88% vs. 24%, p < 0,001) em relação ao pré-operatório. O teste cardiopulmonar revelou melhora do VO2 pico (18,7 ± 5,6 vs. 25,2 ± 6,3 mL/kg/min, p < 0,001), limiar anaeróbico (13,1 ± 3 vs. 17,7 ± 5,5 mL/kg/min, p < 0,001) e velocidade na esteira rolante de 2,5 (2-2,5) para 3 (2,5-3,3) mph, p=0,001. Na análise multivariada, a idade foi o único preditor independente da variação de VO2 (r=-0,658, p=0,003). Os níveis séricos de BNP apresentaram redução significativa de 143 (83,5-209,5) pg/mL para 76 (40-117,5) pg/mL, p=0,011. A polissonografia noturna completa no pré-operatório demonstrou a presença de apneia do sono moderada/ grave (IAH >= 15 eventos/hora) em 13 pacientes, com predomínio de hipopneias. Não houve mudança significativa do índice de apneia-hipopneia após a pericardiectomia: IAH pré 15,6 (8,3-31,7) vs. IAH pós 14,6 (5,75-29,9), p=0,253; entretanto, houve melhora da qualidade do sono (Pittsburgh pré 7,8 ± 4,10 vs. Pittsburgh pós 4,7 ± 3,7, p < 0,001). O IAH apresentou correlação positiva com os níveis de BNP (r=0,418, p=0,037) e EuroSCORE (r=0,480, p=0,015) no pré-operatório. Conclusão: Pacientes com pericardite constritiva crônica sintomática apresentaram, seis meses após a cirurgia de pericardiectomia, melhora da capacidade cardiopulmonar, da classe funcional e da qualidade de vida. A apneia do sono se mostrou frequente e apresentou correlação com níveis séricos de BNP e EuroSCORE no pré-operatório. O índice de apneia-hipopneia não apresentou mudanças significativas após a pericardiectomia. A despeito disso, houve melhora da qualidade do sono / Introduction: Pericardiectomy is the treatment of choice for patients with symptomatic chronic constrictive pericarditis; however, the impact of the procedure on cardiopulmonary capacity and cardiorespiratory physiology during wakefulness and sleep has been poorly studied so far. Objective: To evaluate the impact of pericardiectomy surgery on functional capacity of patients with symptomatic chronic constrictive pericarditis. Methods: This is a prospective observational study with 25 consecutive patients diagnosed with chronic constrictive pericarditis submitted to pericardiectomy. The following procedures were performed one week before and six months after pericardiectomy: clinical and anthropometric evaluation, quality of life and sleep evaluation, serum BNP levels, transthoracic echocardiography, cardiopulmonary exercise test, complete nocturnal polysomnography. Results: The mean age was 45, with a predominance of males (76%). The etiology was mainly idiopathic (76%), followed by tuberculosis (12%). The echocardiogram revealed preserved left ventricular ejection fraction and inferior vena cava dilatation (92%) in most patients. All patients underwent phrenic to phrenic pericardiectomy via median sternotomy, without extracorporeal circulation. After pericardiectomy there was a reduction in: functional class III / IV (56% vs. 8%, p < 0.001), ascites (72% vs. 12%, p < 0.001) and lower limb edema (88% vs. 24%, p < 0.001) as compared to the preoperative period. The cardiopulmonary test revealed improvement in VO2 peak (18.7 ± 5.6 vs. 25.2 ± 6.3 mL/kg/min, p < 0.001), anaerobic threshold (13.1 ± 3 vs. 17.7 ± 5.5 mL/kg/min, p < 0.001) and velocity on the treadmill from 2.5 (2-2.5) to 3 (2.5-3.3) mph, p=0.001. In multivariate analysis, age was the only independent predictor of VO2 variation (r = -0.658, p = 0.003). Serum BNP levels showed a significant reduction from 143 (83.5-209.5) pg/mL to 76 (40-117.5) pg/mL, p=0.011. The complete nocturnal polysomnography in the preoperative period showed moderate / severe sleep apnea (AHI >= 15 events / hour) in 13 patients, predominantly hypopnea. There was no significant change in apnea-hypopnea index after pericardiectomy: AHI pre 15.6 (8.3-31.7) vs. AHI post 14.6 (5.75-29.9), p= 0.253; however, there was improvement in sleep quality (Pittsburgh pre 7.8 ± 4.10 vs. Pittsburgh post 4.7 ± 3.7, p < 0.001). AHI presented a positive correlation with BNP levels (r=0.418, p=0.037) and EuroSCORE (r=0.480; p=0.015) in the preoperative period. Conclusion: Patients with symptomatic chronic constrictive pericarditis showed improvement in cardiopulmonary capacity, functional class and quality of life six months after pericardiectomy. Sleep apnea was frequent and correlated with serum levels of BNP and EuroSCORE in the preoperative period. The apnea-hypopnea index did not show significant changes after pericardiectomy. Nevertheless, there was an improvement in sleep quality

No description available.