Pericardiectomy in pregnancy.

The range of cardiac surgery in pregnancy has been extended from procedures such as mitral valvulotomy and repair of aortic coarctation to include a variety of 'open-heart' operations undertaken with the aid of cardiopulmonary bypass (Ueland, 1965; Zitnik, Brandenburg, Sheldon, and Wallace, 1969). Rheumatic and congenital lesions are the forms of heart disease most frequently encountered in pregnancy (Ueland, 1965), and correction of these lesions has therefore been the type of operation most commonly undertaken. Constrictive pericarditis is a common lesion in those parts of the world where tuberculosis is uncontrolled. Many patients with tuberculosis are infertile, so that the occurrence of pregnancy in patients with constrictive pericarditis is relatively rare. The purpose of this paper is to report the details which relate to a patient in whom pericardiectomy was undertaken in pregnancy. third heart sound. The liver was palpable 9 cm. below the right costal margin, and the spleen 1 cm. below the left. The fundus of the uterus was felt 3 cm. below the umbilicus, consistent with the twenty-fourth week of pregnancy. Foetal heart sounds were normal. Laboratory investigations showed a haemoglobin of 10 5 g. / 100 ml.; a white cell count of 6,000 per cu. mm.; an erythrocyte sedimentation rate of 51 mm. in the first hour; and a blood urea of 18 mg./O00 ml. A tuberculin test was positive. The electrocardiogram (Fig. 1) showed sinus tachycardia, at a rate of 125 per minute, and a mean frontal QRS axis of +10°. low voltage in the standard leads and generalized ST-T wave depression or inversion. The chest radiograph (Fig. 2) showed bilateral pleural effusions, a heart shadow with a