Total pericardiectomy for uremic pericarditis

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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.

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