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Bichali S, Uguen J, Giroux N, Romefort B, Feildel-Fournial C, Dumortier M, Habes D, Caldari D. Sclerotherapy of oesophageal varices may induce chronic constrictive pericarditis in children. Cardiol Young 2023; 33:1186-1188. [PMID: 36220353 DOI: 10.1017/s1047951122003195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Constrictive pericarditis is rare in children and can be difficult to diagnose. It has been described in adults after sclerotherapy of oesophageal varices but not in children. We report two cases of chronic constrictive pericarditis after sclerotherapy of oesophageal varices in children with portal cavernoma. Constrictive pericarditis should be considered as a cause of refractory ascites.
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Affiliation(s)
- Saïd Bichali
- Pediatric and Congenital Cardiology Ward, Department of Pediatrics, Univ. Lille, CHU Lille, F-59000 Lille, France
- Cardio-Pediatrics Unit, Department of Pediatric Specialties, Nantes University Hospital, Nantes, France
| | - Justine Uguen
- Pediatric Infectious Diseases Unit, Department of General Pediatrics, Nantes University Hospital, Nantes, France
| | - Nathan Giroux
- Pediatric and Congenital Cardiology Ward, Nancy University Hospital, Vandœuvre-lès-Nancy, France
| | - Bénédicte Romefort
- Cardio-Pediatrics Unit, Department of Pediatric Specialties, Nantes University Hospital, Nantes, France
| | - Cécile Feildel-Fournial
- Pediatric Infectious Diseases Unit, Department of General Pediatrics, Nantes University Hospital, Nantes, France
| | - Morgane Dumortier
- Pediatric Infectious Diseases Unit, Department of General Pediatrics, Nantes University Hospital, Nantes, France
| | - Dalila Habes
- Pediatric Hepatology and Pediatric Liver Transplantation Unit, National Reference Centre for Rare Pediatric Liver Diseases and Filfoie, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dominique Caldari
- Pediatric Gastro-Enterology Unit, Department of Pediatric Specialties, Nantes University Hospital, Nantes, France
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2
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Krisnanda C, Atmadikoesoemah CA, Kusmanto VB, Soerarso R, Elen, Sugisman, Kasim M. A Case of Extensive Diffuse Calcified Tuberculous Constrictive Pericarditis: Late Presentation Leading to a Devastating Outcome. Heart Lung Circ 2023; 32:e39-e41. [PMID: 37085413 DOI: 10.1016/j.hlc.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/16/2023] [Accepted: 03/07/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Charles Krisnanda
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Indonesian Heart Association, Jakarta, Indonesia.
| | - Celly Anantaria Atmadikoesoemah
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Indonesian Heart Association, Jakarta, Indonesia
| | - Virandra Biramanandi Kusmanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Indonesian Heart Association, Jakarta, Indonesia
| | - Rarsari Soerarso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Indonesian Heart Association, Jakarta, Indonesia
| | - Elen
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Indonesian Heart Association, Jakarta, Indonesia
| | - Sugisman
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Manoefris Kasim
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Indonesian Heart Association, Jakarta, Indonesia
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3
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Kashiwagi Y, Yoshida J, Nagoshi T, Hoshino S, Yoshitake M, Hongo K, Kunihara T, Yoshimura M. Constrictive Pericarditis with Cardiac Ascites Caused Spontaneous Bacterial Peritonitis. Intern Med 2022; 61:1857-1861. [PMID: 34776488 PMCID: PMC9259821 DOI: 10.2169/internalmedicine.8332-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Patients with constrictive pericarditis (CP) typically present with symptoms related to right-sided heart failure, such as cardiac ascites. Spontaneous bacterial peritonitis (SBP) usually arises in association with ascites secondary to hepatic cirrhosis. We herein report a rare case of CP in which SBP developed due to cardiac ascites, even in the absence of cirrhosis. In this case, pericardiectomy improved both the hemodynamics and the ascites, while therapy with diuretics alone was insufficient. It is important to consider SBP in the differential diagnosis when any abdominal symptoms or an inflammatory response is found in patients with heart failure and cardiac ascites.
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Affiliation(s)
- Yusuke Kashiwagi
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Jun Yoshida
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Tomohisa Nagoshi
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Satoshi Hoshino
- Department of Cardiac Surgery, The Jikei University School of Medicine, Japan
| | - Michio Yoshitake
- Department of Cardiac Surgery, The Jikei University School of Medicine, Japan
| | - Kenichi Hongo
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Takashi Kunihara
- Department of Cardiac Surgery, The Jikei University School of Medicine, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
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4
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Mima H, Tamaki Y, Kondo H, Tamura T. Effusive Constrictive Pericarditis Due to Cholesterol Pericarditis. Intern Med 2022; 61:1919-1920. [PMID: 34776489 PMCID: PMC9259808 DOI: 10.2169/internalmedicine.8403-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hibiki Mima
- Department of Cardiology, Tenri Hospital, Japan
| | - Yodo Tamaki
- Department of Cardiology, Tenri Hospital, Japan
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5
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Nakanishi Y, Honda S, Yamano M, Kawasaki T, Yoshioka K. Constrictive pericarditis after SARS-CoV-2 vaccination: A case report. Int J Infect Dis 2022; 116:238-240. [PMID: 35063679 PMCID: PMC8767927 DOI: 10.1016/j.ijid.2022.01.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/30/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) and vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are associated with cardiovascular complications. Here, we report a case of right-sided heart failure caused by constrictive pericarditis that developed after the administration of messenger ribonucleic acid (mRNA) vaccine against SARS-CoV-2. A 70-year-old woman presented with body weight gain, peripheral edema, and dyspnea on effort, which developed over a period of 1 week after the second dose of vaccine. The jugular venous pressure was high with a prominent y descent (Friedreich's sign) and paradoxical increase on inspiration (Kussmaul's sign). The results of IgM and IgG testing specific to SARS-CoV-2 spike and nucleocapsid proteins indicated the presence of mRNA vaccine-induced antibody and were not suggestive of COVID-19 infection. Echocardiography showed pericardial thickening and septal bounce of the interventricular septum. Computed tomography (CT) also showed pericardial thickening compared with the results of the previous CT scan performed 4 months earlier. A diagnosis of right-sided heart failure due to constrictive pericarditis was confirmed on the basis of pressure analysis during cardiac catheterization.
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Affiliation(s)
- Yuki Nakanishi
- Department of Cardiology, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan
| | - Sakiko Honda
- Department of Cardiology, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan.
| | - Michiyo Yamano
- Department of Cardiology, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan
| | - Tatsuya Kawasaki
- Department of Cardiology, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan
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6
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Miyamoto K, Onitsuka H. [Constrictive Pericarditis Associated with Pericardial Hematoma:Report of a Case]. Kyobu Geka 2021; 74:1101-1105. [PMID: 34876541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A 59-year-old man was admitted to our hospital due to keto-acidosis. Electric cardiogram showed history of myocardial infarction. Cardiac echogram showed severe left ventricular hypokinesis, thickened pericardium and pericardial effusion. Right ventricular pressure curve showed dip and plateau pattern, and coronary angiography showed severe three vessel disease. So, we diagnosed with constrictive pericarditis accompanying pericardial effusion and ischemic heart disease. After cardiac catheterization, as the hemodynamics was getting worse, we inserted intraaoric balloon pumping (IABP) immediately and performed an emergent operation. The heart was compressed by hematoma and thickened pericardium. The surrounding tissue of hematoma was organized including fibrous tissue. We resected hematoma and pericardium, and the cardiac function was improved remarkably. His postoperative course was uneventful. The cause of hematoma was thought to be intrapericardial bleeding after cardiac infarction. He had cardiac tamponade and constrictive pericarditis, and the diagnosis of this case was considered to effusive constrictive pericarditis.
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Affiliation(s)
- Kazuyuki Miyamoto
- Department of Cardiovascular Surgery, Fukuoka Kinen Hospital, Fukuoka, Japan
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7
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Affiliation(s)
- Radwan Kassir
- Félix Guyon University Hospital, Saint Denis de la Réunion, France
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8
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Diaz Soto JC, Mauermann WJ, Lahr BD, Schaff HV, Luis SA, Smith MM. MELD and MELD XI Scores as Predictors of Mortality After Pericardiectomy for Constrictive Pericarditis. Mayo Clin Proc 2021; 96:619-635. [PMID: 33673914 DOI: 10.1016/j.mayocp.2020.08.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/27/2020] [Accepted: 08/28/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the association between the preoperative model for end-stage liver disease (MELD) and MELD-XI (exclude international normalized ratio) score and outcomes in patients undergoing pericardiectomy for constrictive pericarditis. PATIENTS AND METHODS Patients >18 years of age undergoing pericardiectomy for constrictive pericarditis between January 1, 2007, and October 12, 2017, were analyzed with data for MELD and MELD-XI score calculation within 30 days preoperatively. The association between the MELD and MELD-XI scoring systems and risk of postoperative outcomes was assessed in regression models adjusting for relevant covariates. The primary outcome was operative mortality (death within 90 days or in hospital). Secondary outcomes included various measures of postoperative morbidity. RESULTS A total of 175 and 226 patients had data for MELD/MELD-XI, respectively. Ninety-day mortality was 8.7%. When stratified into tertiles of MELD-XI, the unadjusted risk of 90-day mortality was 2.7%, 8.2%, and 16.0%, respectively. In Cox regression models fitted for MELD-XI and MELD, higher scores associated with increased risk of mortality (P<.001 for both). In secondary multivariable analyses, both MELD-XI and MELD were associated with increased incidence of renal failure and greater levels of chest-tube output and transfusion, whereas MELD-XI was additionally associated with prolonged intubation and extended intensive care unit and hospital stays. CONCLUSION Among patients undergoing pericardiectomy for constrictive pericarditis, MELD-XI and MELD were associated with increased postoperative morbidity and mortality. Although the simpler MELD-XI score generally performed as well or better than MELD as a correlate of various outcomes, both scores can serve as a simple yet robust risk stratification tool for patients undergoing pericardiectomy for constrictive pericarditis.
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Affiliation(s)
- Juan C Diaz Soto
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - William J Mauermann
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Brian D Lahr
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Hartzell V Schaff
- Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Sushil A Luis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Mark M Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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Kousik V, Milap M, Bollam R, Prasad RK, Krishna G. Squamous Cell Carcinoma of Thymus Presenting as Constrictive Pericarditis Diagnosed With 18F-FDG PET/CT. Clin Nucl Med 2021; 46:e13-e15. [PMID: 32701799 DOI: 10.1097/rlu.0000000000003193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Constrictive pericarditis refers to focal or global thickening of pericardium causing impedance to diastolic filling and increased systemic venous pressure. We discuss a case of thymic carcinoma presenting as constrictive pericarditis. A 70-year-old man experiencing shortness of breath underwent Doppler echocardiography for further evaluation. Echocardiography was suggestive of thickened nodular pericardium with minimal pericardial effusion, and Doppler features were suggestive of constrictive pericarditis. F-FDG PET/CT done to exclude malignancy reveals locally advanced thymic carcinoma spreading along the pericardial sheath with metabolically active rib metastases.
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Affiliation(s)
| | | | | | | | - Gopi Krishna
- Pulmonary Medicine, Yashoda Super Speciality Hospital, Secunderabad, India
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10
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Rivera PA, Borgarelli M. Cardiovascular images: constrictive pericarditis and tricavitary effusion in a dog with pericardial mesothelioma. J Vet Cardiol 2020; 32:55-59. [PMID: 33137660 DOI: 10.1016/j.jvc.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 09/12/2020] [Accepted: 09/17/2020] [Indexed: 11/19/2022]
Abstract
This report describes the transthoracic echocardiographic findings and computed tomography features of a 12-year-old West Highland white terrier with constrictive pericarditis (CP) secondary to pericardial mesothelioma. Although pericardial mesothelioma is well described in dogs, its association with CP in the canine population is not as widely reported. In this clinical case, a multidisciplinary imaging approach was helpful to identify anatomical and hemodynamic abnormalities that allowed for a diagnosis of CP.
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Affiliation(s)
- P A Rivera
- Virginia-Maryland College of Veterinary Medicine, 205 Duck Pond Dr, Blacksburg, VA, 24060, USA.
| | - M Borgarelli
- Virginia-Maryland College of Veterinary Medicine, 205 Duck Pond Dr, Blacksburg, VA, 24060, USA
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11
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Ogura H, Kimata R, Mitta S, Umeda E, Ishida N, Shimabukuro K, Nakashima T, Kanamori H, Kawasaki M, Doi K. Neovascularization in pericarditis: a possible etiology of hemopericardium. Gen Thorac Cardiovasc Surg 2019; 68:392-395. [PMID: 30968260 DOI: 10.1007/s11748-019-01124-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 04/02/2019] [Indexed: 12/01/2022]
Abstract
Hemorrhagic pericardial effusion is life-threatening and mostly occurs during pericarditis; however, its underlying mechanism is unclear. We report a case of pericardial hematoma with obvious hemorrhage. A 56-year-old man without prior chest trauma presenting with exertional dyspnea and abdominal fullness was treated for idiopathic pericarditis. The echocardiogram showed a thickened pericardium with effusion. Imaging showed extravasation and neovascularization. Following ineffective pharmacotherapy, we performed pericardiectomy. The site of bleeding was undetectable. Because parietal pericardiectomy with hematoma evacuation did not improve diastolic function, we removed the epicardium. During the follow-up period, the patient remained almost asymptomatic. We identified neovascularization as the potential source of idiopathic pericardial hemorrhage.
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Affiliation(s)
- Hiroki Ogura
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan.
| | - Ryutaro Kimata
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Shohei Mitta
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Etsuji Umeda
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Narihiro Ishida
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Katsuya Shimabukuro
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Takashi Nakashima
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Gifu, 501-1194, Japan
| | - Hiromitsu Kanamori
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Gifu, 501-1194, Japan
| | - Masanori Kawasaki
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Gifu, 501-1194, Japan
| | - Kiyoshi Doi
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
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12
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Abstract
Constrictive pericarditis (CP) is defined as impedance to diastolic filling caused by a fibrotic pericardium. The diagnosis of CP is a clinical challenge and requires a high index of clinical suspicion. The signs and symptoms of CP include fatigue, edema, ascites, and liver dysfunction. These can be mistakenly diagnosed as primary liver disease. We present the case of a 69-year-old woman with a 7-year history of leg edema and a 2-year history of ascites who was initially diagnosed with cryptogenic liver cirrhosis and was finally diagnosed with CP.
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Affiliation(s)
- Takahiro Kamio
- Heart Center, Tokyo Bay Urayasu-Ichikawa Medical Center, Japan
| | - Eiji Hiraoka
- Department of Internal Medicine, Tokyo Bay Urayasu-Ichikawa Medical Center, Japan
| | - Kotaro Obunai
- Heart Center, Tokyo Bay Urayasu-Ichikawa Medical Center, Japan
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13
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Cardells I, Payá A, Bondanza L, Miñana G, González M, Núñez J. Peritoneal Dialysis in Constrictive Pericarditis: A Report of Three Cases. Rev Esp Cardiol (Engl Ed) 2017; 70:504-506. [PMID: 27810236 DOI: 10.1016/j.rec.2016.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 07/22/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Ingrid Cardells
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Ana Payá
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Lourdes Bondanza
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Miguel González
- Servicio de Nefrología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain.
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14
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Affiliation(s)
- James Sb Kho
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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15
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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.
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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: )
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16
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Granel B, Gaudy C, Serratrice J, Ene N, Mesana T, Bonnet JL, Lepidi H, Disdier P, Piana L, Weiller PJ. Severe Lower Limbs Lymphedema Following Breast Carcinoma Treatment Revealing Radiation-Induced Constrictive Pericarditis. Angiology 2016; 56:119-21. [PMID: 15678267 DOI: 10.1177/000331970505600118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In patients treated for breast carcinoma, unilateral lymphedema of the upper limb is usual. However, to the authors’ knowledge, lower limb lymphedema has never been reported as a complication of breast carcinoma therapy. They report here the first case of a radiation-induced constrictive pericarditis revealed by severe lower limbs lymphedema. A 60-year-old woman was treated for left breast carcinoma with quadrantectomy, axillary lymphadenectomy, and combined radio chemotherapy (60 grays). Three and a half years later she suffered from a diffuse and increasing lower limbs lymphedema, which became huge and disabling. Radiation-induced constrictive pericarditis was evidenced by right cardiac cavities catheterization. A dramatic improvement was rapidly obtained after pericardectomy. Histopathologic analysis of the pericardium did not reveal neoplastic cells. Radiation-induced constrictive pericarditis is usually responsible for lower limbs edema, but lymphedema is exceptional. This case highlights the need to search for a constrictive pericarditis also in the case of lower limbs lymphedema, particularly in a patient treated with mediastinal radiotherapy or combined radio chemotherapy.
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Affiliation(s)
- B Granel
- Service de Médecine Interne, CHU Timone, Marseille, France
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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Kawatsu S, Takahara S, Sakatsume K, Kanda K, Suzuki T, Katahira S, Fujiwara H, Adachi O, Akiyama M, Kumagai K, Kawamoto S, Saiki Y. [Preoperative Use of Tolvaptan in a Patient with Constrictive Pericarditis]. Kyobu Geka 2016; 69:121-125. [PMID: 27075153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Tolvaptan is a new selective vasopression V2-receptor antagonist. We report our experience with a use of tolvaptan for preoperative fluid management in a patient with severe constrictive pericarditis. A 66-year-old man presented with heart failure symptoms derived from constrictive pericarditis. Chest X-ray showed right pleural effusion and chest computed tomography demonstrated severe pericardial calcification. Despite that he received optimal conventional medical treatments, his hemodynamic condition further exacerbated during hospitalization. We administered tolvaptan in an attempt to optimize preoperative fluid management. Tolvaptan was found to be remarkably effective in that regard. The body weight decreased and the heart failure symptoms improved. Pericardiectomy was performed successfully, and he recovered uneventfully.
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Affiliation(s)
- Satoshi Kawatsu
- Division of Cardiovascular Surgery, Tohoku University, Graduate School of Medicine, Sendai, Japan
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19
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Takakura H, Sunada K, Shimizu K. [TUBERCULOUS CONSTRICTIVE PERICARDITIS DETECTED ON POSITRON EMISSION TOMOGRAPHY]. Kekkaku 2016; 91:65-68. [PMID: 27263228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 72-year-old man presented with fever, dyspnea, and weight loss. He was referred to our hospital for further examination of the cause of the pleural effusions. Chest computed tomography showed pleural effusions, a pericardial effusion, and enlarged lymph nodes in the carina tracheae. We administered treatment for heart failure and conducted analyses for a malignant tumor. The pericardial effusion improved, but the pericardium was thickened. Positron emission tomography-computed tomography (PET-CT) showed fluorine-18 deoxyglucose accumulation at the superior fovea of the right clavicle, carina tracheae, superior mediastinum lymph nodes, and a thickened pericardium. Because these findings did not suggest malignancy, we assumed this was a tuberculous lesion. Echocardiography confirmed this finding as constrictive pericarditis; therefore, pericardiolysis was performed. Pathological examination showed features of caseous necrosis and granulomatous changes. Hence, the patient was diagnosed with tuberculous constrictive pericarditis. PET-CT serves as a useful tool for the diagnosis of tuberculous pericarditis.
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20
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Li L, Deng YB, Liu K, Guo LD, Liu HY, Zhou W, Tang QY. Long-Term Effects of Pericardiectomy on Left Ventricular Mechanics Evaluated by Using Speckle Tracking Echocardiography in Patients with Constrictive Pericarditis. Ultrasound Med Biol 2016; 42:421-429. [PMID: 26653938 DOI: 10.1016/j.ultrasmedbio.2015.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 09/21/2015] [Accepted: 10/29/2015] [Indexed: 06/05/2023]
Abstract
The aim of this study was to evaluate long-term changes in left ventricular (LV) mechanics after pericardiectomy in patients with constrictive pericarditis (CP) and to correlate post-operative LV mechanics with clinical status. A total of 24 patients with CP underwent serial speckle tracking echocardiography 1 wk before and 1, 6 and 12 mo after pericardiectomy. Global LV longitudinal, circumferential and radial strains, along with LV twist, were measured. Twenty-three healthy volunteers were served as control patients. Although global LV longitudinal, circumferential and radial strains obtained 6 mo after pericardiectomy increased compared with those for pre-pericardiectomy, they were still significantly lower than those for control patients. Further improvements occurred over time with normalization of global LV longitudinal and radial strains 12 mo after pericardiectomy, but global circumferential strain obtained 12 mo after pericardiectomy was still lower than that for control patients. LV twist remained unchanged after pericardiectomy. In addition, the improvements in global LV circumferential strain after pericardiectomy were associated with improvements in clinical symptoms (p < 0.001). These findings suggest that the global LV circumferential strain may be a promising parameter in the evaluation of the effectiveness of pericardiectomy.
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Affiliation(s)
- Li Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - You-Bin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Kun Liu
- Department of Medical Ultrasound, Minda Hospital of Hubei University For Nationalities, Enshi, China
| | - Ling-Dan Guo
- Department of Medical Ultrasound, Wuhan Center Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong-Yun Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Zhou
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiao-Ying Tang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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21
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Man MA, NiŢu MF, Strâmbu L, Florescu C, Streba CT, Trofor AC. Tuberculous constrictive pericarditis complicated with tuberculous mediastinitis - case report. Rom J Morphol Embryol 2016; 57:237-42. [PMID: 27151714 DOI: pmid/27151714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Constrictive pericarditis is a rare and severe disease. A 37-year-old patient was admitted in the hospital for dyspnea, precordial pain, right-sided cardiac failure. Chest X-ray showed cardiac enlargement and an opacity suggestive for pleural effusion. Echocardiography revealed an adhesive-effusive-constrictive pericarditis, a very thickened pericardium and bilateral pleural effusion. After a pericardiectomy done to restore cardiac compensation and to identify etiological factors, a tuberculous pericarditis (TBP) was diagnosed. After surgery and starting anti-TB treatment, the patient presented altered clinical status, dyspnea, dry cough, fever and delayed callus formation at sternum level. Thoracic scan revealed mediastinal air collections, pericarditis and pleurisy. Thus, the TBP diagnosis was extended to mediastinal TB and anti-TB therapy was continued. After four months of treatment, another thoracic scan showed disappearance of the mediastinal air-leakage bubbles, multiple new micronodules in both lungs and lymph nodes of up to 15 mm; also increasing pericardial and pleural effusions. This case was interpreted as a TB treatment failure situation. A retreatment regimen was started, resulting in a slow favorable outcome. Pericardial TB is a rare condition, usually with delayed diagnosis and poor treatment benefits. Whenever possible, earlier diagnostic can contribute to better management of these cases.
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Affiliation(s)
- Milena Adina Man
- Department of Pneumology, University of Medicine and Pharmacy of Craiova, Romania;
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22
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Shin KH, Joo HD, Song IH. Nutmeg liver cardiac cirrhosis caused by constrictive pericarditis. Korean J Intern Med 2015; 30:938-9. [PMID: 26552474 PMCID: PMC4642028 DOI: 10.3904/kjim.2015.30.6.938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 11/10/2014] [Accepted: 11/26/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | - Il Han Song
- Correspondence to Il Han Song, M.D. Tel: +82-41-550-3924 Fax: +82-41-556-3256 E-mail:
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23
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Uchino M, Yoshikai M, Sato H, Ikeda K. [Surgical Repair of Severely Calcific Constrictive Pericarditis;Report of a Case]. Kyobu Geka 2015; 68:468-471. [PMID: 26066882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 74-year-old male presented with exertional dyspnea and leg edema. Chest X-ray and computed tomography demonstrated dense calcification of the pericardium. Based on a diagnosis of constrictive pericarditis, pericardiectomy was performed without the use of extracorporeal circulation. During the operation, we employed a Harmonic Scalpel (Naginata-type) to peel off the calcified pericardium around the right and left ventricles. The calcified pericardium around the right atrium was found to be so firmly adhered to the atrial wall that peeling off the calcified tissue was difficult. Therefore, we used a Cavitron Ultrasonic Surgical Aspirator (CUSA) to break down the calcification. After the surgery, the patient's dyspnea on exertion and leg edema resolved, and he recovered without any complications. Regarding the surgical treatment of severely calcific constrictive pericarditis, Naginata-type Harmonic Scalpel and CUSA are very useful for peeling off the calcified tissue of the pericardium and/or breaking down the calcification.
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Affiliation(s)
- Motonori Uchino
- Department of Cardiovascular Surgery, Shin-Koga Hospital, Kurume, Japan
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24
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Seidler S, Lebowitz D, Müller H. [Chronic constrictive pericarditis]. Rev Med Suisse 2015; 11:1166-1171. [PMID: 26182634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Chronic constrictive pericarditis is a rare condition characterized by an impairment of myocardial relaxation due to limitation by a rigid pericardium. It is most often associated with infection, thoracic radiotherapy and heart surgery. Clinical features are that of chronic heart failure, therefore non-specific and resulting in a delay of several years before diagnosis is made. The echocardiogram and heart catheterization are part of the initial work-up. Surgical treatment consisting in pericardiectomy can be curative if the disease is recognised early. This article makes use of a case report and review of the litterature to discuss the physiopathology, clinical features and management of chronic constrictive pericarditis.
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25
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Ben Ahmed H, Bouzouita K, Hamdi I, Khalifa S, Boujnah MR. Calcific constrictive pericarditis. Tunis Med 2013; 91:739-740. [PMID: 24458682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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26
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Laghari AH, Tai JM. Heavily thickened pericardium with constrictive pericarditis. J PAK MED ASSOC 2013; 63:639-641. [PMID: 23757998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A middle-aged male presented with symptoms of exertional shortness of breath and leg swelling for the past six months. Examination revealed raised jugular venous pressure (JVP), pitting pedal oedema, muffled heart sounds, bilateral pleural effusion and hepatomegaly. Echocardiogram showed features of constrictive pericarditis with heavily thickened pericardium, which was confirmed by cardiac computed tomography (CT). The patient underwent pericardiectomy following which echocardiographic features of constriction were reversed and the patient became asymptomatic.
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Affiliation(s)
- Abid Hussain Laghari
- Section of Cardiology, Department of Medicine, Aga Khan University Hospital, Karachi
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27
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Eleid MF, Borlaug BA, Mulvagh S. Digging deeper into dyspnea. Am J Med 2013; 126:e5-6. [PMID: 23410579 DOI: 10.1016/j.amjmed.2012.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 11/07/2012] [Indexed: 11/16/2022]
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Abstract
An 87-year-old man with a diagnosis of constrictive pericarditis suffered from cough syncope up to 10 times per day on most days during his three-day stay at our hospital. After undergoing a series of treatments (diuretics, codeine and intravenous ceftizoxime), the patient still had a mild cough, although he did not experience any further syncopal episodes associated with coughing. Two months later, the syncopal episodes associated with coughing returned, but at a lower rate.
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Affiliation(s)
- Wanshu Zeng
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, China
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29
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Kikuchi S, Ohte N, Wakami K, Goto T, Kimura G. Low cardiac output in a case of constrictive pericarditis with protein-losing enteropathy. Intern Med 2013; 52:75-9. [PMID: 23291677 DOI: 10.2169/internalmedicine.52.8811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A man in his late seventies was suffering from right-sided pleural effusion and worsening leg edema. He was diagnosed with a rare case of secondary protein-losing enteropathy caused by constrictive pericarditis (CP) using technetium 99m-labeled human serum albumin abdominal scintigraphy and comprehensive Doppler echocardiography. We herein report the importance of evaluating a low cardiac output in addition to established Doppler echocardiographic findings for making a diagnosis of CP coexistent with protein-losing enteropathy.
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Affiliation(s)
- Shohei Kikuchi
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan
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30
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Abusaid GH, Khalife WI. Reduced coronary blood flow in cardiac tamponade: mystery solved. J Invasive Cardiol 2012; 24:E328-E329. [PMID: 23220996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 67-year-old male presented with several week history of progressive shortness of breath, lower extremity edema, and distended jugular veins. Transthoracic echocardiography showed moderate pericardial effusion with thickened visceral pericardium and septal bounce but no chamber collapse. Right and left cardiac catheterization showed discordance of the right and left ventricular systolic pressures during respiration and severely reduced cardiac output. There was near equalization of diastolic pressures in all four chambers suggestive of effusive-constrictive pericarditis with cardiac tamponade physiology. Simultaneous coronary angiography showed remarkably reduced coronary Thrombolysis in Myocardial Infarction (TIMI) flow (TIMI grade 2 flow). Coronary blood flow was restored to normal after pericardial drainage on repeat coronary angiography. This is the first report of reduced coronary blood flow on coronary angiography in patients with effusive-constrictive pericarditis and cardiac tamponade. Our finding complements the work of previous investigators as we show that elevated intrapericardial pressures in cardiac tamponade can reduce coronary blood flow. This is likely related to extrinsic epicardial coronary vessel compression and reduced perfusion pressures, which can lead to myocardial ischemia and eventually cardiogenic shock.
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Affiliation(s)
- Ghassan H Abusaid
- Department of Internal Medicine-Cardiology Division, University of Texas Medical Branch, JSA 5.106G, Galveston, TX 77555-0553, USA.
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Adhikari P, Pathak UN, Uprety D, Sapkota S. Profile of ascites patient admitted in Nepal Medical College Teaching Hospital. Nepal Med Coll J 2012; 14:111-113. [PMID: 23671959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Ascites is one of the frequently encountered problems in internal medicine. Common causes of ascites are portal hypertension including cirrhosis of liver and congestive heart failure, hypoalbuminemia associated with nephrotic syndrome, intra-abdominal malignancy and abdominal tuberculosis. We evaluated 43 patients presented with ascites in Nepal Medical College Teaching Hospital (NMCTH). After history taking, clinical examination, imaging studies and laboratory evaluation alcoholic liver disease and abdominal tuberculosis were diagnosed in 19 and 5 patients restively. Constrictive pericarditis was diagnosed in 2 patients and 2 patients were suffering from HCV related liver disease. Present study revealed alcoholic liver disease as the commonest cause of ascites.
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Affiliation(s)
- P Adhikari
- Department of Internal Medicine, Nepal Medical College Teaching Hospital, Jorpati, Kathmandu, Nepal.
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33
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Nasser M, Madonna R, Cevik C. Segmental diastolic compression of circumflex coronary artery secondary to pericardial constriction: an uncommon cause of angina pectoris. J Invasive Cardiol 2012; 24:E90-E92. [PMID: 22562928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Diastolic segmental compression of a native coronary artery is an uncommon cause of chest pain. Here we describe a 24-year-old woman with constrictive pericarditis who had retrosternal chest pain, progressive dyspnea, tachycardia, and bilateral leg edema. She was diagnosed with compression of the first and second obtuse marginal branches of left circumflex coronary artery secondary to constrictive pericarditis. She underwent pericardiectomy and her symptoms were relieved following surgery.
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Affiliation(s)
- Maher Nasser
- Texas Heart Institute and St. Luke's Episcopal Hospital, Houston, TX 77030, USA.
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Akhtar N, Khalid A, Razaque S, Ahmed W, Ahmed M. Mixed constrictive pericarditis and restrictive cardiomyopathy in a 36-year-old female. J PAK MED ASSOC 2012; 62:508-510. [PMID: 22755323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Mixed lesion of Restrictive Cardiomyopathy and Constrictive Pericarditis is a rarely reported clinical entity which poses a diagnostic and therapeutic enigma to physicians. The management of both conditions differs markedly. Restrictive Cardiomyopathy is managed either conservatively or cardiac transplant may be offered. On the other hand, Constrictive Pericarditis can be surgically treated by pericardiectomy. We report a rare case of decompensated heart failure presenting with mixed features of both constrictive and restrictive cardiomyopathy.
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Affiliation(s)
- Naveed Akhtar
- Department of Cardiology, Shifa International Hospital, Islamabad, Pakistan
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35
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De Dios Pérez S, Jurado Román A. [Calcified constrictive pericarditis: heart in cuirass]. Med Clin (Barc) 2012; 138:e3. [PMID: 21513958 DOI: 10.1016/j.medcli.2011.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 02/28/2011] [Indexed: 11/19/2022]
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36
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Kozieradzka A, Kamiński KA, Tycińska AM, Hirnle T, Sobkowicz B. Drainage of pleural effusions in the course of unrecognised constrictive pericarditis: a cause of severe haemodynamic deterioration. Kardiol Pol 2012; 70:615-617. [PMID: 22718384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Constrictive pericarditis (CP) is a rare disease which can be easily overlooked in the absence of typical pericardial calcification. One of its most frequent manifestations is pleural effusion. We present a case report of a patient with unrecognised CP in whom plerocentesis led to haemodynamic collapse, and we speculate about the potential pathomechanism. No obvious criterion of CP or severe systolic dysfunction was found in baseline echocardiography. We consider that patients with advanced CP are remarkably prone to haemodynamic decompensation secondary to pleural drain.
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Affiliation(s)
- Anna Kozieradzka
- Department of Cardiology, Medical University of Bialystok, Poland
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Soma K, Takahashi M, Sato T, Nagai R. Angina as a manifestation of constrictive pericarditis. Intern Med 2012; 51:1939. [PMID: 22821119 DOI: 10.2169/internalmedicine.51.7820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Katsura Soma
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Japan
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38
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Gökçe I, Gökçe S, Kılıç A, Bozlar U, Kocaoğlu M, Ongürü O, Gök F. Familial Mediteranean fever with protein-losing enteropathy due to constrictive pericarditis. World J Pediatr 2011; 7:365-7. [PMID: 21210266 DOI: 10.1007/s12519-011-0255-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 03/21/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Constrictive pericarditis (CP) represents a rare cause of protein-losing enteropathy (PLE) resulting from intestinal lymphangiectasia (IL). In this report, we describe an 8-year-old Turkish boy with IL and PLE secondary to CP. METHODS The boy was introduced to our clinic due to bilateral pretibial edema and swelling of the eyelids caused by hypoproteinemia. Physical examination revealed a distended right jugular vein. Laboratory investigation revealed PLE with fecal concentration of alpha-1 antitripsin of 4.87 mg/g. Histopathologic examination of random biopsies obtained from the duodenum revealed markedly dilated lymphatics compatible with IL. Constrictive pericarditis was diagnosed by tagged cine cardiac magnetic resonance imaging. RESULTS Pericardiectomy was performed for the patient. Genetic analysis was done and heterozygous mutation E148Q was detected as a disease-causing Mediterranean fever (MEFV) mutation. Colchicine was started after the operation. Six months after the initiation of regular colchicine therapy, echocardiography revealed disappearance of CP. CONCLUSION This is the first reported case of PLE with a distended right jugular vein due to CP secondary to familial Mediterranean fever associated with E148Q heterozygosity in the MEFV gene.
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Affiliation(s)
- Ibrahim Gökçe
- Department of Pediatric Nephrology and Rheumatology, Gülhane Military Academy of Medicine, School of Medicine, 06018 Etlik, Ankara, Turkey.
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40
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Naeem M, Sobani ZA, Zubairi A, Fatmi S, Khan JA. Constrictive pericarditis presenting as chylothorax. Singapore Med J 2011; 52:e187-e189. [PMID: 21947162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Chylothorax is a rare clinical condition that can be attributed to a damaged thoracic duct. The condition is suggested by aspiration of milky white fluid from the pleural cavity and is commonly associated with either malignant diseases or trauma (e.g. cardiothoracic surgery). We present the case of a 15-year-old boy with chylothorax, whose effusion was due to constrictive pericarditis. The definitive treatment of chylothorax involves identification and management of the underlying pathology. We suggest that when dealing with cases of chylothorax, constrictive pericarditis should be considered among the causes.
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Affiliation(s)
- M Naeem
- Respiratory Medicine, Kettering General Hospital, Rothwell Road, Kettering, Northamptonshire NN168UZ, UK
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41
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Affiliation(s)
- Michael C Reed
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109-5869, USA.
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42
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Lima MV, Cardoso JN, Cardoso CMDR, Brancalhão ECO, Limaco RP, Barretto ACP. Constrictive pericarditis with extensive calcification. Arq Bras Cardiol 2011; 96:e7-e10. [PMID: 21308337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 02/22/2010] [Indexed: 05/30/2023] Open
Abstract
A patient with signs and symptoms of right heart failure of unknown etiology was referred to a referral hospital in the eastern area of the city of São Paulo with a diagnosis of calcified constrictive pericarditis and was treated by surgery. This pathology is characterized by an irreversible process of pericardium calcification, and surgery is the only alternative to control the symptoms and improve patients' quality of life. This case drew special attention due to the extensive calcification involving the interventricular septum. The unusual aspect of the images has made the diagnosis difficult and raised doubts about the existence of an associated disease.
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43
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Holden E, Ranu H, Madden BP. A case of progressive breathlessness. BMJ 2010; 341:c4655. [PMID: 20861100 DOI: 10.1136/bmj.c4655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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44
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Mohan P, Venkataraman J. Medical image. Refractory ascites due to ascites praecox. N Z Med J 2010; 123:88-89. [PMID: 20717183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Pazhanivel Mohan
- Department of Gastroenterology, Stanley Medical College, Old jail road, Royapuram, Chennai - 600001, India.
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45
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Castañón-González JA, Amézquita-Landeros JA, Velasco-Ortega EC, Deseano-Estudillo JL, León-Gutiérrez MA. [Constrictive pericarditis: the story of a constrained heart]. CIR CIR 2010; 78:342-346. [PMID: 21167101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Symptoms of constrictive pericarditis may be nonspecific, misleading and may delay or lead to an incorrect diagnosis. CLINICAL CASE We present the case of a 28-year-old male who was admitted to the hospital with progressive dyspnea, thoracic pain and a history of 25 kg of weight gain during the last 2 years. He was evaluated at another facility and his clinical presentation led to an erroneous diagnosis of primary hepatic disease (cirrhosis and portal hypertension). Physical examination showed that he was dyspneic, emaciated, had marked distention of his frontal cranial veins, diminished heart sounds, massive ascites and leg edema. Laboratory tests reported abnormal liver function tests and abdominal paracentesis chylous ascites. Electrocardiogram showed sinus rhythm with generalized low voltage and nonspecific repolarization changes. Heart size was normal on chest radiography. Doppler echocardiography reported bilateral atrial dilatation, a thickened pericardium and a short deceleration time of transmitral flow. A thickened and calcified pericardium was seen on CT scan. Pericardiectomy was performed. Spontaneous polyuria was observed during and after surgery with subsequent improvement of ascites and edema. The pericardium was found to be grossly thickened and inflamed. CONCLUSIONS Clinician must be aware of the slow and progressive course of right ventricular failure, as well as to recognize constrictive pericarditis as a cause of chronic ascites.The hemodynamic aspects of the disease are of paramount importance for early diagnosis and opportune treatment.
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Affiliation(s)
- Jorge Alberto Castañón-González
- Unidad de Cuidados Intensivos y Medicina Crítica, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D. F., Mexico.
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Affiliation(s)
- Mark A. Crandall
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - Sharon L. Mulvagh
- Adviser to resident and Consultant in Cardiovascular Diseases, Mayo Clinic, Rochester, MN
- Individual reprints of this article are not available. Address correspondence to Sharon L. Mulvagh, MD, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905 ()
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Jolly N, Goel A, Raman J. Inability of intracoronary stenting to provide long-term relief for coronary compression secondary to chronic constrictive pericarditis. J Invasive Cardiol 2010; 22:E13-E15. [PMID: 20048402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Chronic constrictive pericarditis can result in extrinsic compression of coronary arteries during diastole. We present one such case wherein the coronary compression and the resultant cardiac ischemia developed late after surgical pericardiectomy, and treatment with intracoronary stenting was unsuccessful. Issues pertaining to management of this rare condition are discussed and a case made for surgical treatment for such patients.
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Affiliation(s)
- Neeraj Jolly
- University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 5076, Chicago, IL 60637, USA.
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Blagova OV, Tsaregorodtsev DA, Nedostup AV, Maevskaia IV, Petukhova NV, Troitskaia MP, Shadaniia IR. [Severe disseminated constrictive polyserositis in a patient with rheumatoid arthritis]. TERAPEVT ARKH 2010; 82:56-61. [PMID: 20731114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Constrictive polyserositis (pleuritis, pericarditis) is a syndrome within the underlying disease (tuberculosis, periodic disease, rheumatoid arthritis, systemic lupus erythematosus, asbestos, silicosis, uremia, some genetic diseases), a complication due to chest surgery or radiation or drug therapy, is occasionally idiopathic (fibrosing mediastinitis). There are frequently great difficulties in making its nosological diagnosis. The paper describes a patient in whom the onset of disease was exudative pleurisy with the signs of constriction, arthralgias; pleural punctures provided serous exudates with 80% lymphocytes. A year later there was ascitis and shin and foot edemas, which concurrent with hepatomegaly and cholestasis was regarded as cryptogenic liver cirrhosis. The signs of constrictive pericarditis were further revealed. The disease was complicated by the development of pulmonary artery thromboembolism (PATE) (which required the use of warfarin) and hemorrhagic vasculitis. Therapy with metipred in combination with isoniazid yielded a slight effect. The diagnoses of tuberculosis, liver cirrhosis, and autoimmune hepatitis, systemic vasculitis were consecutively rejected; the diagnosis of rheumatoid polyarthritis with systemic manifestations was made, by taking into account persistent arthalgias with the minimum signs of arthritis, noticeably increased C-reactive protein, rheumatoid factor, and cyclic citrullinated peptide antibodies (CCPA); plasmapheresis, therapy with metipred and methotrexate, and subtotal pericardectomy were performed. Constrictive polyserositis concurrent with PATE, hemorrhagic vasculitis (probably, drug-induced one), and hepatic lesion has been first described in a CCPA-positive patient with rheumatoid arthritis in the presence of moderate true arthritis (during steroid therapy).
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Yalonetsky S, Lorber A. Percutaneous closure of a secundum atrial septal defect after surgical pericardectomy. Cardiovasc J Afr 2009; 20:353-354. [PMID: 20024476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
A case of successful closure of a percutaneous atrial septal defect following surgical pericardectomy is described. Clinical and haemodynamic aspects of atrial septal defects associated with constrictive pericarditis are also discussed.
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Affiliation(s)
- S Yalonetsky
- Congenital Cardiac Centre for Adults, University Health Network, Toronto, Canada.
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Erbel R, Lind A, Plato C, Kühl H, Piotrowski J, Jakob H, Schmid KW, Sack S. [Davos lecture 2004: Pericarditis constrictiva with severe pericardial effusion diagnosed with significant therapeutic consequences]. Herz 2009; 29:563-7. [PMID: 15340745 DOI: 10.1007/s00059-004-2618-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Raimund Erbel
- Klinik für Kardiologie, Universitätsklinikum Essen, Essen
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