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Results for “PERICARDITIS, CONSTRICTIVE”

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PubMed1989

Differentiation of constrictive pericarditis and restrictive cardiomyopathy by radionuclide ventriculography.

Patterns of left ventricular diastolic filling in five patients with unoperated constrictive pericarditis, the same five patients following pericardiectomy, five patients with restrictive cardiomyopathy, and 14 healthy control subjects were studied by radionuclide ventriculography. Patients with constrictive pericarditis had more rapid peak left ventricular filling rates (mean 5.62, range 4.23 to 7.32 end-diastolic volumes [EDV] per second) compared to control subjects 3.44, range 2.62 to 4.45 EDV/sec, p less than 0.05). Heart rate-corrected first one-third and first one-half diastolic filling fractions were greater in patients with preoperative constrictive pericarditis compared to members of the restrictive cardiomyopathy and control groups p less than 0.05). Following pericardiectomy, patients with constrictive pericarditis had significant decreases in peak filling rate and corrected filling fractions, and all diastolic filling measurements were indistinguishable from those of control subjects. These noninvasively obtained data indicate that patients with preoperative constrictive pericarditis have an increased rate of left ventricular early diastolic filling compared to patients with restrictive cardiomyopathy and control subjects, and that these findings return to normal following surgical removal of the pericardium.

Adult↗

PubMed1979

Constrictive pericarditis: early and late complication of cardiac surgery.

Constrictive pericarditis is not considered a complication of cardiac surgery. However, three cases are presented in which equalization of diastolic pressures and the ventricular pressure pattern of early diastolic dip-late diastolic plateau, characteristic of restrictive disease, appeared after cardiac surgery. In one patients cardiac constriction developed less than 2 weeks after surgery, and loculated clotted and unclotted viscous blood was removed from the pericardial space. In the other two patients the pericardial space was obliterated by dense adhesions. Thus constrictive pericarditis should be considered in postoperative patients who either do not recuperate satisfactorily after surgery or whose condition deteriorates after initial recovery.

Aged↗

PubMed1995

Predictors of constrictive pericarditis after tuberculous pericarditis.

OBJECTIVE: To identify features which predict the subsequent development of constrictive pericarditis from acute or subacute tuberculous (TB) pericarditis. SETTING: Tertiary referral centre, chest hospital. PATIENTS: The records of 16 consecutive patients in whom acute or subacute TB pericarditis was diagnosed between 1988 and 1990 at a chest hospital were reviewed. These records included a follow up of at least 12 months. RESULTS: During a follow up of 14.2 (12-30) months, 8 patients had constrictive pericarditis diagnosed by cardiac catheterisation or by inspection at the time of operation (group A). There was no evidence of constriction in the other eight patients (group B). There was no significant difference between the two groups in the type or duration of symptoms of TB pericarditis before admission or the volume and characteristics of pericardial fluid obtained at hospital admission. Clinical features of cardiac tamponade on admission correlated closely with the subsequent development of constrictive pericarditis requiring pericardectomy (7/8 v 2/8; P = 0.01), despite the fact that the signs of tamponade resolved completely after pericardiocentesis. CONCLUSION: The findings suggest that cardiac tamponade in the early clinical stage of TB pericarditis is the most predictive factor of subsequent constrictive pericarditis. The degree of fibrosis of pericardium when treatment starts may be the most important determinant of whether or not constriction develops.

Adult↗

PubMed1993

Worsening tricuspid regurgitation following pericardiectomy for constrictive pericarditis.

We describe two cases of worsening tricuspid regurgitation following surgical pericardiectomy for constrictive pericarditis. Both patients demonstrated hemodynamic profiles characteristic of constrictive pericarditis on cardiac catheterization. They also had moderate tricuspid regurgitation as judged by Doppler echocardiography. The worsening tricuspid regurgitation observed was a result of postoperative right ventricular dilatation. These cases demonstrate the importance of determining tricuspid valvular function in patients with constrictive pericarditis prior to pericardiectomy; however, the hemodynamic changes that result in worsening tricuspid regurgitation may not be present for weeks.

Aged↗

PubMed1996

[Chronic constrictive pericarditis apropos of 3 cases disclosed by refractory cardiac failure].

Chronic constrictive pericarditis is a difficult diagnosis and may present atypically. The authors report three clinical cases and review the diagnostic strategy of constrictive pericarditis. In these three patients, the diagnosis was finally made after one or more years of symptomatic disease and after several diagnostic work ups and ineffective treatments. In cardiac failure, pericardial calcification is often not observed on chest X-ray and Doppler echocardiography is usually the diagnostic investigation. Adiastole presents with dilatation of the vena cava and atria, contrasting with normal ventricles without major valvular disease. Doppler echocardiography enables distinction of constrictive pericarditis from restrictive cardiomyopathy: normal myocardium, thickened pericardium, specific septal motion, inspiratory increase in right ventricular dimensions, premature opening of the pulmonary valve, important variations in ventricular filling with respiration, expiratory diastolic reflux in the hepatic veins. Catheterisation confirms adiastole and may suggest a pericardial aetiology in characteristic cases, associated with only mild increases in pulmonary artery pressure. If need be, the pericardial thickening > 4 mm may be observed with magnetic nuclear resonance imaging and, when a doubt remains with respect to the diagnosis of cardiomyopathy, the absence of fibrosis on endomyocardial biopsy provides the diagnosis and indication for curative surgery: pericardectomy.

Chronic Disease↗

PubMed1983

Aetiology of chronic constrictive pericarditis.

In a consecutive series of 32 cases of chronic constrictive pericarditis treated by pericardiectomy during the past 25 years, four were attributable to rheumatoid disease, two to trauma, one to sarcoidosis, and four, at a maximum, to tuberculosis. In the remaining 21 cases of undetermined aetiology there was no evidence of tuberculosis. It appears, therefore, that tuberculosis was not a common cause of chronic constrictive pericarditis during the period under review, which included the 1950s and early 1960s when tuberculosis was widespread.

Adolescent↗

PubMed1989

[Postoperative constrictive pericarditis].

Seven cases of postoperative constrictive pericarditis (PCP) were discovered in a retrospective study of patients given heart surgery in a hospital receiving patients from all over Italy in 1970-85. Five of those patients had received surgery for chronic rheumatic heart disease, 2 for congenital heart defects. Four had received a second heart operation before the pericardial condition was recognised. All were females and all presented systemic venous hypertension (one of them only after acute doses of physiological solution) with thickening of the pericardial layers revealed by sonography. In six cases the electrocardiographic ventricular complexes were normal or increased in amplitude and the heart/chest ratio was greater than 0.55. Pericardial knock was masked by natural or artificial atrioventricular valve opening noises in 6 cases. In one case only there were pericardial calcifications or signs of an earlier postpericardiotomy syndrome. The haemodynamic investigation revealed signs of ventricular diastolic constriction in 6 patients. Three patients died from complications of cardiac cirrhosis: 2 of them had previously received partial pericardiectomy. Another two, given the same operation, preserved a reasonable functional capacity 5 and 10 years after the pericardiectomy. One patient in NYHA functional class III has so far refused haemodynamic assessment (and surgical treatment) of the pericardial disease. Finally, the last patient complains only of attacks of heart palpitation caused by atrial flutter and controlled by antiarrhythmic treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

Restrictive cardiomyopathy and constrictive pericarditis: non-invasive distinction by digitised M mode echocardiography.

It is difficult to distinguish between restrictive cardiomyopathy and constrictive pericarditis on the basis of clinical findings and simple investigation. Cardiac catheterisation has been the reference standard for diagnosis but even this does not always permit an accurate distinction. A Summagraphics digitiser and Prime 750 computer system were used to digitise the echocardiograms of 15 patients with restrictive cardiomyopathy, 10 with constrictive pericarditis and a group of 20 age and sex matched normal subjects of similar age and sex distribution. Compared with controls, patients with restrictive cardiomyopathy showed a significant reduction in the following variables (a) decreased fractional shortening, (b) decreased peak left ventricular filling and emptying rates, (c) decreased percentage posterior wall thickening, and (d) decreased peak left ventricular posterior wall thickening and thinning rates. Whereas patients with constrictive pericarditis only had significantly reduced peak left ventricular filling and posterior wall thinning rates and significantly increased posterior wall thinning rate. When patients with restrictive cardiomyopathy were compared with those with constrictive pericarditis the significant differences were: (a) decreased peak left ventricular emptying rate, (b) decreased percentage posterior wall thickening, and (c) decreased peak left ventricular posterior wall thickening and thinning rates. Digitisation of M mode echocardiograms, with particular attention to posterior wall function, may be a useful adjunct to cardiac catheterisation in distinguishing restrictive cardiomyopathy from constrictive pericarditis.

Adult↗

PubMed2004

Constrictive pericarditis: case presentation and a review of the literature.

Constrictive pericarditis (CP) is a relatively rare entity, the result of a thickened, scarred and often calcified pericardium, adherent to the heart and limiting diastolic ventricular filling. Some reported etiologies for CP include pericardial involvement from cardiac trauma (including surgery), mediastinal irradiation, tuberculosis and other infectious diseases, neoplasms and myocardial infarction. However, the majority of CP cases are idiopathic. This report presents three cases of postoperative, tuberculous and idiopathic CP, highlighting the clinical and pathological changes seen in CP, and a review of the literature.

Adult↗

PubMed2003

Constrictive pericarditis in 26 patients with histologically normal pericardial thickness.

BACKGROUND: Traditionally, increased pericardial thickness has been considered an essential diagnostic feature of constrictive pericarditis. Although constriction with a normal-thickness pericardium has been demonstrated clinically by noninvasive imaging, the details of clinicopathological correlates have not been described. METHODS AND RESULTS: A total of 143 patients with proven constriction underwent pericardiectomy at Mayo Clinic between 1993 and 1999. Their baseline characteristics, operative data, and pathological specimens were reviewed retrospectively. The pericardium was of normal thickness (< or =2 mm) in 26 patients (18%; group 1) and was thickened (>2 mm) in 117 (82%; group 2). The most common causes of constriction in group 1 included previous cardiac surgery, chest irradiation, previous infarction, and idiopathic disease. There was little difference in symptoms and findings on physical examination between the 2 groups. Microscopically, no patient had an entirely normal pericardium. Histopathological abnormalities in group 1 were mild and focal, including fibrosis, inflammation, calcification, fibrin deposition, and focal noncaseating granulomas. Pericardiectomy was equally effective in relieving symptoms regardless of the presence or absence of increased thickness. CONCLUSIONS: Pericardial thickness was not increased in 18% of patients with surgically proven constrictive pericarditis, although the histopathological appearance was focally abnormal in all cases. When clinical, echocardiographic, or invasive hemodynamic features indicate constriction in patients with heart failure, pericardiectomy should not be denied on the basis of normal thickness as demonstrated by noninvasive imaging.

Adult↗

PubMed1994

[Chronic constrictive pericarditis. A retrospective study of a series of 84 patients].

Chronic constrictive pericarditis still poses diagnostic and therapeutic problems. A series of 84 cases (59 men-25 women; men age: 46 years) operated between 1979 and 1989 at the Pitié Hospital was reviewed. The majority of patients (72%) were in functional Classes III or IV; 88% had clinical signs of right ventricular failure and 18% had anasarca. The average duration of symptoms before diagnosis was 20 months. Chest X-ray showed pericardial calcification in 40% of cases. A characteristic dip-plateau pressure tracing was obtained in 76% of cases. A specific aetiology was only found in 36 cases (45%), only 12% being of tuberculous origin. A subtotal pericardectomy from phrenic to phrenic was carried out in 75 patients. The absence of planes of cleavage in 9 cases imposed a special operative technique consisting of "patchwork" sectioning of the visceral pericardium. The operative mortality was 2.3% (2 patients: pulmonary embolism and septicaemia). Non-fatal post-operative complications occurred in 8.2% of cases (7 patients). The survival rate excluding operative mortality was 94% at 3 years and 87% at 7 years. No patient was reoperated for recurrent constrictive pericarditis. At the last follow-up appointment, all patients were in functional Classes I or II. The authors conclude that the absence of specific symptoms, the low prevalence of the condition and the change in aetiology related to the decline in tuberculous infection make the diagnosis of chronic constrictive pericarditis very difficult. The diagnostic contributions of new imaging techniques such as CT and MR scanning should be assessed. This series confirms the efficacy of surgical treatment by subtotal pericardectomy.

Adult↗

PubMed1989

[Significance of disturbances of cardiac filling in constrictive pericarditis].

Using pulsed Doppler echocardiography, blood filling patterns of the right atrium and left and right ventricles in constrictive pericarditis were studied to evaluate the physiological role of the pericardium in the hemodynamics of this disease. Thirteen cases were examined including five cases with atrial fibrillation. The control subjects consisted of 16 healthy persons and six cases of lone atrial fibrillation. 1. Peak velocity of the atrial filling wave during ventricular systole was reduced, and the filling time was shortened, suggesting reduced compliance and restricted motion of the atrial wall, because of the thickening and adhesions of the pericardium. Duration of the atrial filling wave during ventricular diastole was also shortened, reflecting disturbance of the early diastolic filling of the right ventricle. 2. In healthy subjects, duration of the rapid filling wave was longer in the right ventricle than in the left ventricle, probably due to the greater compliance of the right ventricular wall as compared to that of the left ventricular wall. In constrictive pericarditis, the rapid filling time of the right ventricle is shortened, so that the difference in this time between the right and left ventricles is minimized, which may be related to a thinner right ventricular wall. Duration of the rapid filling wave of the right ventricle correlated with right ventricular end-diastolic pressure, indicating that the duration of the right ventricular rapid filling wave is proportional to the severity of constrictive pericarditis. In conclusion, constriction of the pericardium definitely influences the hemodynamics of the right side of the heart more than it does the left side in constrictive pericarditis. This difference appears to result from the difference in thickness of the myocardial layers of both ventricles.

Adult↗

PubMed2000

Constrictive pericarditis. Early experience in 12 patients in light of modern cardiology.

The last several decades have witnessed major advances in the understanding and management of constrictive pericarditis. The aim of the present study was to compare the diagnosis, treatment and outcome of constrictive pericarditis of 40 years ago to today. The study population consisted of 12 patients with a diagnosis of constrictive pericarditis who presented at the Institute of Cardiology of Beilinson Hospital, from 1961 to 1970. Their main physical findings, electrocardiographic and chest X-ray changes, and hemodynamic study results are discussed in relation to the surgical outcome of patients with constrictive pericarditis today. New noninvasive imaging modalities, such as M mode, two-dimensional and Doppler echocardiography, computed tomography and magnetic resonance imaging are presented, and their advantages and disadvantages in the diagnosis of constrictive pericarditis and its differentiation from restrictive cardiomyopathy are explained.

Adolescent↗

PubMed2005

[Ascites due to constrictive pericarditis].

INTRODUCTION: We report a case in which ascites revealed chronic constrictive pericarditis (CCP) of tuberculous origin. OBSERVATION: A 65 year-old man had developed ascites the past over few weeks and oedema of the lower limbs. Treatment was surgical and consisted in pericardiectomy. DISCUSSION: Chronic constrictive pericarditis has become rare in industrialised countries with the reduction in the incidence of tuberculosis. Currently, its principle aetiologies identified are previous cardiac surgery and radiotherapy. Treatment is usually surgical and gives excellent results. This clinical case clearly illustrates the interest of systematic biological analysis of ascites, since it may reveal a curable disease.

Aged↗

PubMed2004

Differentiation of constrictive pericarditis from restrictive cardiomyopathy using mitral annular velocity by tissue Doppler echocardiography.

This study evaluated the diagnostic role of early diastolic mitral annular velocity (E') by tissue Doppler echocardiography for differentiating constrictive pericarditis from restrictive cardiomyopathy (primary restrictive cardiomyopathy and cardiac amyloidosis). The study group consisted of 75 patients (53 men, 22 women; mean age 62 years, range 27 to 87). Of these, 23 patients had surgically confirmed constrictive pericarditis, 38 had biopsy-proved systemic amyloidosis and typical echocardiographic features of cardiac involvement, and 14 had primary restrictive cardiomyopathy. Standard mitral inflow characteristics were measured. Tissue Doppler echocardiography was used to measure E' at the septal annulus. E' was significantly higher in patients with constrictive pericarditis than in those with primary restrictive cardiomyopathy or cardiac amyloidosis (12.3 vs 5.1 cm/second, p <0.001). An E' cut-off value > or =8 cm/second resulted in 95% sensitivity and 96% specificity for the diagnosis of constrictive pericarditis. There was no overlap of E' between patients who had constrictive pericarditis and those who had cardiac amyloidosis. In a subgroup analysis of restrictive cardiomyopathy, E' of patients who had cardiac amyloidosis was significantly lower than that of patients who had primary restrictive cardiomyopathy (4.6 vs 6.3 cm/second, p <0.001). Thus, E' velocity can distinguish between constrictive pericarditis and restrictive cardiomyopathy with a specific cut-off value in patients with clinical and echocardiographic evidence of diastolic heart failure.

Aged↗

PubMed2006

Protein-losing enteropathy in association with constrictive pericarditis.

Although acute pericarditis is a common and usual benign disorder, sometimes evolution to constrictive pericarditis may occur. We present a case of constrictive pericarditis late after coronary bypass grafting, complicated by right sided heart failure. Edema formation was aggravated due to protein-losing enteropathy, resulting in hypoalbuminemia. Imaging of constrictive pericarditis was done by ultrasound as well as simultaneous pressure recording of the right and left ventricle. Imaging of intestinal protein loss was possible using intravenous Technetium-99m-labelled human serum albumin.

Aged↗

PubMed2000

Constrictive pericarditis after bypass leading to internal mammary graft failure.

Constrictive pericarditis is an infrequent consequence of cardiac operation. The etiology remains unknown, but the consequences include a restrictive process that leads to congestive failure and diminished cardiac output. In addition, the desmoplastic reaction, associated with fusion of the visceral and parietal pericardial layers, has been implicated in failure of saphenous vein grafts. We report a case of constrictive pericarditis, after coronary bypass operation, with occlusion of an internal mammary graft.

Humans↗

PubMed1991

[Vena caval flow patterns in patients with constrictive pericarditis: analysis by catheter-tip Doppler flowmetry].

Changes in superior and inferior vena caval flow patterns were analyzed in 5 patients with constrictive pericarditis and were compared with those of 10 normal control subjects. Caval flows were measured using catheter-tip Doppler flowmeters. The normal controls showed biphasic M-shaped flow patterns; the peaks of the first forward flow (S wave) and of the second forward flow (D wave) appeared coincident with mid-systole and mid-diastole, respectively. Reverse flows fell during the atrial contraction period (A wave) and late systole (V wave). In the normal controls, the ratios of the S wave to the D wave (S/D ratio) and the A wave to the S wave (A/S ratio) were 2.15 +/- 0.41 and 0.18 +/- 0.10, respectively, and there was a disproportionate respiratory variation in the S and D waves in the normal controls. In constrictive pericarditis, superior and inferior vena caval flow velocities were lower than those in the normal controls. The S/D and A/S ratios were 1.46 +/- 0.27 (p < 0.05 vs control) and 0.66 +/- 0.15 (p < 0.01 vs control), respectively, with the A wave increasing in proportion to the severity of constrictive pericarditis. In addition, there was only a minimal respiratory variation in constrictive pericarditis. In conclusion, recognition of the patterns of the superior and inferior vena caval flow velocities may be useful for diagnosing constrictive pericarditis.

Adult↗