1
|
Antonopoulos AS, Vrettos A, Androulakis E, Kamperou C, Vlachopoulos C, Tsioufis K, Mohiaddin R, Lazaros G. Cardiac magnetic resonance imaging of pericardial diseases: a comprehensive guide. Eur Heart J Cardiovasc Imaging 2023; 24:983-998. [PMID: 37207354 DOI: 10.1093/ehjci/jead092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Indexed: 05/21/2023] Open
Abstract
Cardiac magnetic resonance (CMR) imaging has been established as a valuable diagnostic tool in the assessment of pericardial diseases by providing information on cardiac anatomy and function, surrounding extra-cardiac structures, pericardial thickening and effusion, characterization of pericardial effusion, and the presence of active pericardial inflammation from the same scan. In addition, CMR imaging has excellent diagnostic accuracy for the non-invasive detection of constrictive physiology evading the need for invasive catheterization in most instances. Growing evidence in the field suggests that pericardial enhancement on CMR is not only diagnostic of pericarditis but also has prognostic value for pericarditis recurrence, although such evidence is derived from small patient cohorts. CMR findings could also be used to guide treatment de-escalation or up-titration in recurrent pericarditis and selecting patients most likely to benefit from novel treatments such as anakinra and rilonacept. This article is an overview of the CMR applications in pericardial syndromes as a primer for reporting physicians. We sought to provide a summary of the clinical protocols used and an interpretation of the major CMR findings in the setting of pericardial diseases. We also discuss points that are less well clear and delineate the strengths and weak points of CMR in pericardial diseases.
Collapse
Affiliation(s)
- Alexios S Antonopoulos
- 1st Cardiology Department, Hipporkration Hospital, National and Kapodistrian University of Athens, 114 Vas Sofias Avenue 11527 Athens Greece
- Clinical, Experimental Surgery & Translational Research Center, Biomedical Research Foundation of the Academy of Athens, 4 Soranou Efesiou Street, 11527, AthensGreece
| | - Apostolos Vrettos
- Department of Cardiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Emmanouil Androulakis
- CMR Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Chelsea, London
| | - Christina Kamperou
- 1st Cardiology Department, Hipporkration Hospital, National and Kapodistrian University of Athens, 114 Vas Sofias Avenue 11527 Athens Greece
| | - Charalambos Vlachopoulos
- 1st Cardiology Department, Hipporkration Hospital, National and Kapodistrian University of Athens, 114 Vas Sofias Avenue 11527 Athens Greece
| | - Konstantinos Tsioufis
- 1st Cardiology Department, Hipporkration Hospital, National and Kapodistrian University of Athens, 114 Vas Sofias Avenue 11527 Athens Greece
| | - Raad Mohiaddin
- CMR Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Chelsea, London
| | - George Lazaros
- 1st Cardiology Department, Hipporkration Hospital, National and Kapodistrian University of Athens, 114 Vas Sofias Avenue 11527 Athens Greece
| |
Collapse
|
2
|
Yang Z, Wang H, Lv Q, Du X, Zhu J, Dong J. Case Report: “Gourd-Shaped” Heart Strangled by Localized Annular Calcification of the Left Ventricle: A Rare Case of Constrictive Pericarditis. Front Cardiovasc Med 2022; 9:834262. [PMID: 35187134 PMCID: PMC8854651 DOI: 10.3389/fcvm.2022.834262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022] Open
Abstract
We report a rare case of a 43-year-old woman with calcific annular constrictive pericarditis (CP) encircling the basal segment of the right ventricle and the mid-segment of the left ventricle (LV) lateral wall. Over time, localized calcification has caused LV to be tightly strangled and shaped like a gourd. However, multimodality imaging confirmed no significantly clinical constriction associated with decreased cardiac movement and function. Additionally, cardiac magnetic resonance feature tracking confirmed the relatively preserved diastolic function and the characteristic “plateau” pattern of CP. The treatment strategy of this case is challenging and dialectical.
Collapse
Affiliation(s)
- Zhiyun Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qiang Lv
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Junming Zhu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- Department of Cardiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- *Correspondence: Jianzeng Dong
| |
Collapse
|
3
|
Localized constrictive pericarditis resulting in biventricular aneurysm-like apical outpouching. Anatol J Cardiol 2020; 25:139-142. [PMID: 33583821 DOI: 10.14744/anatoljcardiol.2020.75062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
4
|
Ojha V, Vadher A, Chandrashekhara SH, Kumar S. Constrictive Pericarditis With a Right Ventricular Apical Outpouching Masquerading as a Diverticulum. Ann Thorac Surg 2019; 108:e203. [PMID: 30885855 DOI: 10.1016/j.athoracsur.2019.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 02/07/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Vineeta Ojha
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Akash Vadher
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - S H Chandrashekhara
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.
| |
Collapse
|
5
|
Abstract
INTRODUCTION Localized pericardium restriction is a rare disease and likely to be unrecognized owing to the atypical manifestation, even after diagnostic avenues are exhausted. Recognizing the red flags of the disease could timely spark a preliminary suspicion of the disease and thus contribute to the early application of relevant examinations. CASE PRESENTATION We will here report a case of a 21-year-old young man with a giant right ventricular outflow tract. He was presented to our hospital for further evaluation of progressive right heart failure which had been previously diagnosed as cardiomyopathy. Unlike patients with right heart failure owing to the restrictive cardiomyopathy, our patient's tissue Doppler revealed an increased early diastolic septal mitral annular velocity. In addition, the disproportion between the severity of right heart failure and the degree of myocardial dysfunction could not be completely explained by other myocardial disease, suggesting that alternative diagnosis of the patient should be sought. Subsequently, cardiac computed tomography, which revealed the focally calcific pericardium encircling the left ventricle, gave us a clue to the diagnosis of localized constrictive pericarditis. Cardiac catheterization, showing the "dip and plateau" sign, further confirmed this diagnosis. The patient underwent successful pericardiectomy. Nowadays, he is able to undertake ordinary physical activity. CONCLUSION Localized constrictive pericarditis should be suspected in patients for whom the severity of heart failure and deformity of heart might not be completely explained by valvular heart disease or myocardial disease.
Collapse
Affiliation(s)
| | | | | | - Bi-Lian Yu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
- Correspondence: Bi-Lian Yu, Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, #139 Middle Renmin Road, Changsha, Hunan 410011, People,s Republic of China (e-mail: )
| |
Collapse
|
6
|
Ni Q, Yun L, Xu R, Li G, Yao Y, Li J. A rare chronic constrictive pericarditis with localized adherent visceral pericardium and normal parietal pericardium: a case report. Front Med 2016; 10:356-9. [PMID: 27527362 DOI: 10.1007/s11684-016-0467-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/12/2016] [Indexed: 11/25/2022]
Abstract
Classic constrictive pericarditis (CP) is characterized by fibrous scarring and adhesion of both the visceral pericardium and the parietal pericardium, which leads to restricted cardiac filling. However, diagnosing CP with normal thickness pericardium and without calcification is still a challenge. The predominant cause in the developed world is idiopathic or viral pericarditis followed by post-cardiac surgery and post-radiation. Tuberculosis still remains a common cause of CP in developing countries. In this report, we describe a rare case of idiopathic localized constrictive visceral pericardium with normal thickness of the parietal pericardium in a middle-aged man. The patient presented with unexplained right heart failure and echocardiography showed moderate bi-atrial enlargement which should be identified with the restrictive cardiomyopathy. After 10 months of conservative treatment, the progression of right heart failure was remaining. A pericardiectomy was performed and the patient recovered. This case serves as a reminder to consider CP in patients with unexplained right heart failure, so that timely investigation and treatment can be initiated.
Collapse
Affiliation(s)
- Qingqiang Ni
- Medical College of Soochow University, Suzhou, 215123, China
| | - Lin Yun
- Department of Medicine, Jinan Maternity and Child Care Hospital, Jinan, 250001, China
| | - Rui Xu
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014, China.
| | - Guohua Li
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014, China
| | - Yucai Yao
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014, China
| | - Jiamin Li
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014, China
| |
Collapse
|
7
|
Ding X, Zhu M, Wei C, Zhu H, Zhang X, Qu X, Li Y, Yuan J. Double cardiac diverticula after pericardectomy. Int J Cardiol 2015; 201:449-53. [PMID: 26313864 DOI: 10.1016/j.ijcard.2015.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 08/01/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Xiao Ding
- Department of Ultrasonography, The People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Meihua Zhu
- Department of Pediatric Cardiology, Oregon Health & Science University, Portland, OR 97239, United States
| | - Changhua Wei
- Department of Ultrasonography, The People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Haohui Zhu
- Department of Ultrasonography, The People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Xijun Zhang
- Department of Ultrasonography, The People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Xuezheng Qu
- Department of Ultrasonography, The People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Yang Li
- Department of Ultrasonography, The People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China
| | - Jianjun Yuan
- Department of Ultrasonography, The People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China.
| |
Collapse
|