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Lahdhili H, Lajmi M, Messaoudi A, Ziadi M, Chenik S. Constrictive epicarditis. Tunis Med 2019; 97:818-821. [PMID: 31872414] [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: 06/10/2023]
Abstract
Constrictive pericarditis is relatively uncommon. Constrictive phenomenon involves in the majority of cases the two layers of the pericardium namely the parietal pericardium and the visceral one. Chronic epicarditis is a distinct and very scarce form where only the visceral pericardium is interested by the pathologic process. We present herein the case of a 25 years old patient admitted in our department for surgical treatment of a chronic visceral pericarditis. We discuss along some important clinical and therapeutic points related to this specific presentation with a special interest to the right ventricular dysfunction after pericardiectomy.
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Liu S, Ren W, Zhang J, Ma C, Yang J, Zhang Y, Guan Z. Incremental Value of the Tissue Motion of Annular Displacement Derived From Speckle-Tracking Echocardiography for Differentiating Chronic Constrictive Pericarditis From Restrictive Cardiomyopathy. J Ultrasound Med 2018; 37:2637-2645. [PMID: 29603321 DOI: 10.1002/jum.14625] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/14/2018] [Accepted: 02/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The tissue motion of annular displacement provides an accurate and rapid assessment of left ventricular (LV) systolic function. However, it has rarely been used in patients with chronic constrictive pericarditis and restrictive cardiomyopathy. This study aimed to assess the differences in LV systolic function in patients with constrictive pericarditis and restrictive cardiomyopathy using tissue motion of annular displacement derived from speckle-tracking echocardiography. METHODS Twenty-four patients with constrictive pericarditis, 24 with restrictive cardiomyopathy, and 25 healthy volunteers (controls) were enrolled. The septal and lateral mitral annular longitudinal displacements, displacement at the midpoint, and normalized midpoint displacement of the mitral ring were calculated. RESULTS Mitral annular tracking and quantification of the tissue motion of annular displacement were achieved within 10 seconds. In patients with constrictive pericarditis, the lateral mitral annular longitudinal displacement, displacement at the midpoint, and midpoint displacement of the mitral ring were decreased, whereas the septal mitral annular longitudinal displacement was preserved compared to controls, indicating that the reduction of systolic function in constrictive pericarditis was caused by pericardial adhesion and calcium. In patients with restrictive cardiomyopathy, tissue motion of annular displacement was more reduced compared to patients with constrictive pericarditis and controls. The correlation between the septal mitral annular longitudinal displacement and left ventricular ejection fraction was 0.67 (P < .001). A cutoff value of 8.45 mm for the septal mitral annular longitudinal displacement could effectively differentiate constrictive pericarditis from restrictive cardiomyopathy with 95.2% sensitivity and 91.7% specificity. CONCLUSIONS The tissue motion of annular displacement was decreased in patients with constrictive pericarditis, which indicated early impairment of longitudinal function in constrictive pericarditis; adhesion and calcium in the pericardium might account for the reduction. The septal mitral annular longitudinal displacement provides a fast and effective method for the assessment of LV systolic function in patients with constrictive pericarditis and restrictive cardiomyopathy.
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Affiliation(s)
- Shuang Liu
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, Shenyang, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, Shenyang, China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, Shenyang, China
| | - Yan Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhengyu Guan
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, Shenyang, China
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Abstract
PURPOSE OF REVIEW Echocardiography is the mainstay in the diagnostic evaluation of constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM), but no single echocardiographic parameter is sufficiently robust to accurately distinguish between the two conditions. The present review summarizes the recent advances in echocardiography that promise to improve its diagnostic performance for this purpose. The role of other imaging modalities such as cardiac computed tomography, magnetic resonance imaging, and invasive hemodynamic assessment in the overall diagnostic approach is also discussed briefly. RECENT FINDINGS A recent study has demonstrated improved diagnostic accuracy of echocardiography with integration of multiple conventional echocardiographic parameters in to a step-wise algorithm. Concurrently, the studies using speckle-tracking echocardiography have revealed distinct and disparate patterns of myocardial mechanical abnormalities in CP and RCM with their ability to distinguish between the two conditions. The incorporation of machine-learning algorithms into echocardiography workflow permits easy integration of the wealth of the diagnostic data available and promises to further enhance the diagnostic accuracy of echocardiography. New imaging algorithms are continuously being evolved to permit accurate distinction between CP and RCM. Further research is needed to validate the accuracy of these newer algorithms and to define their place in the overall diagnostic approach for this purpose.
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Affiliation(s)
- Ahmad Mahmoud
- Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
| | - Manish Bansal
- Heart Institute - Division of Cardiology, Medanta- The Medicity, Gurgaon, India
| | - Partho P Sengupta
- Heart and Vascular Institute, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506, USA.
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Han L, Li X, Zhang G, Xu Z, Gong D, Lu F, Liu X. Pericardial interstitial cell senescence responsible for pericardial structural remodeling in idiopathic and postsurgical constrictive pericarditis. J Thorac Cardiovasc Surg 2017; 154:966-975.e4. [PMID: 28456362 DOI: 10.1016/j.jtcvs.2017.03.115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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] [Received: 03/17/2016] [Revised: 03/04/2017] [Accepted: 03/20/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Idiopathic and postsurgical constrictive pericarditis is characterized by pericardial structural remodeling that involves fibrosis, calcification, and inflammation. This study aimed to determine whether cell senescence was responsible for pericardial structural remodeling. METHODS Pericardial interstitial cells derived from patients with idiopathic or postsurgical pericarditis (pericarditis cells) were harvested. Timing of senescence and differences in telomere length were compared between age- and sex-matched controls (nonpericarditis cells). Pericardial interstitial cells derived from normal pericardia were serially passaged until senescence (senescent cells). Apoptosis, collagen matrix, calcium deposition, chemoattractant properties, gene expression profiles, and paracrine effects of senescent cells were compared with nonsenescent cells of passage 2 (nonsenescent cells). RESULTS Pericarditis cells displayed senescent changes, including short telomere length, large flattened cell sizes, positive staining for senescence-associated β-galactosidase, and limited growth capacity. These senescent cells were resistant to apoptosis, produced more collagen matrix, deposited more calcium, and attracted more monocytes/lymphocytes than the nonsenescent cells. A cluster of genes involved in extracellular matrix deposition (connective tissue growth factor, fibronectin, collagen type I, collagen type III, and tissue inhibitors of metalloproteinase-1), calcium deposition (osteopontin, bone sialoprotein, osteonectin, and matrix Gla protein), and inflammatory cell recruitment (interleukin-6, chemoattractant protein-1, and tumor necrosis factor-α) were upregulated in senescent cells, whereas extracellular matrix-degrading enzyme (metalloproteinase-1 and metalloproteinase-3) was downregulated. Furthermore, senescent cells had the ability to promote the proliferation, differentiation, and senescence of neighboring cells. CONCLUSIONS These findings suggest that senescent cells have characteristics promoting pericardial structural remodeling, but further work is needed to establish causation.
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Affiliation(s)
- Lin Han
- Institute of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xin Li
- Institute of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Guanxin Zhang
- Institute of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhiyun Xu
- Institute of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Dejun Gong
- Institute of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Fanglin Lu
- Institute of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xiaohong Liu
- Institute of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
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5
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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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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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Bogaert J, Meyns B, Dymarkowski S, Sinnaeve P, Meuris B. Calcified Constrictive Pericarditis: Prevalence, Distribution Patterns, and Relationship to the Myocardium. JACC Cardiovasc Imaging 2015; 9:1013-4. [PMID: 26508388 DOI: 10.1016/j.jcmg.2015.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 06/15/2015] [Revised: 08/13/2015] [Accepted: 08/20/2015] [Indexed: 11/17/2022]
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Abstract
Abnormal thickening or rigidity of the pericardium may compromise normal cardiac function. This condition is known as pericardial constriction, or constrictive pericarditis. Several imaging modalities are used to evaluate the pericardium, including MR, computed tomography, and echocardiography, which can all play a complementary role aiding diagnosis. This article focuses on MR imaging and its role in the detection and evaluation of pericardial constriction. MR imaging has many advantages compared with other modalities including precise delineation of the pericardial thickness, evaluation of ventricular function, detection of wall motion abnormalities, and provision of information about common (and potentially harmful) sequelae of pericardial constriction.
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Affiliation(s)
- Robert Groves
- Department of Radiology, Virginia Commonwealth University, 1250 E Marshall St, Richmond, VA 23219, USA
| | - Danielle Chan
- Department of Radiology, Indiana University, 550 North University Boulevard, Room 0663, Indianapolis, IN 46202, USA
| | - Marianna Zagurovskaya
- Department of Radiology, Virginia Commonwealth University, 1250 E Marshall St, Richmond, VA 23219, USA
| | - Shawn D Teague
- Department of Radiology, Indiana University, 550 North University Boulevard, Room 0663, Indianapolis, IN 46202, USA.
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Magishi K, Izumi Y, Shimizu N. [Rapid transition from purulent to constrictive pericarditis]. Kyobu Geka 2014; 67:463-466. [PMID: 24917402] [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: 06/03/2023]
Abstract
A 48-year-old woman experienced a high fever and precordial pain. Computed tomography revealed pericardial fluid, and she was diagnosed with viral pericarditis. The pericardial fluid gradually increased, and she experienced pre-shock. Pericardial drainage was therefore performed, and the fluid was found to be purulent on the 11th day. Pleural effusion and ascites retention, then increased, and she was diagnosed with constrictive pericarditis on the 21st day by the date of the right ventricular pressure. Excision of the pericardium was performed through median sternotomy on the 27th day after the onset. As the ventricular diastolic function improved, the heart swelled, and sternal closure became impossible. It was finally closed 5 days after the surgery. The patient had no recurring infection, and was discharged on the 36th postoperative day. Although purulent pericarditis is a rare disease, you should keep in mind that it may progress rapidly to constrictive pericarditis.
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Affiliation(s)
- Katsuaki Magishi
- Department of Cardiovascular Surgery, Nayoro City General Hospital, Nayoro, Japan
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Alraies MC, Kusunose K, Negishi K, Yarmohammadi H, Motoki H, AlJaroudi W, Popović ZB, Klein AL. Relation between echocardiographically estimated and invasively measured filling pressures in constrictive pericarditis. Am J Cardiol 2014; 113:1911-6. [PMID: 24837273 DOI: 10.1016/j.amjcard.2014.03.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 01/16/2014] [Revised: 03/05/2014] [Accepted: 03/05/2014] [Indexed: 11/28/2022]
Abstract
The ratio of early transmitral flow velocity (E) to mitral annular velocity (E') is considered a predictor of pulmonary capillary wedge pressure (PCWP). In a previous small study, the paradoxical relation between PCWP and E/E' ratio has been described in patients with constrictive pericarditis (CP). We sought to test this paradoxical relation in a larger cohort. We retrospectively identified 49 patients with surgically confirmed CP (40 men; mean age 61 ± 10 years) who underwent right-sided cardiac catheterization with PCWP measurement, preceded by an echocardiographic study. Of these, 48 patients underwent either computed tomography or magnetic resonance imaging to measure pericardial thickness on the lateral side of the left ventricular wall. Mean interval time between echocardiogram and right-sided cardiac catheterization was 1.5 ± 3.8 days. There were no significant correlations between mean, medial, or lateral E/E' and PCWP (r = -0.17, 95% confidence interval [CI] -0.43 to -0.12; r = -0.17, 95% CI -0.43 to -0.12; and r = -0.12, 95% CI -0.39 to -0.17, respectively). Similarly, there was no correlation between mean E/E' and brain natriuretic peptide (Spearman r = -0.17, p = NS). Patients with increased pericardial thickness (defined as >4 mm) had both lower lateral peak systolic annular velocity (S') and lower lateral S' integral (7.8 ± 2.4 vs 9.6 ± 2.4, p = 0.02 and 13.2 ± 4.2 vs 15.9 ± 4.7, p = 0.04, respectively). In patients with CP, there were no correlations between septal, lateral, or mean E/E' and PCWP. In conclusion, E/E' is not predictive of filling pressures in patients with CP, and perhaps the "annulus paradoxus" phenomenon should be revisited. The relation between the mitral annular velocity and thickness of the parietal pericardium may affect this phenomenon.
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Affiliation(s)
- M Chadi Alraies
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kazuaki Negishi
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hirad Yarmohammadi
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Wael AlJaroudi
- Division of Cardiovascular Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zoran B Popović
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Allan L Klein
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Bijvoet GP, Cramer MJ, Uijlings R, Kirkels JH, Schipper MEI. Charcoal or chocolate: what captures the heart? J Clin Pathol 2012; 65:859-61. [PMID: 22554969 DOI: 10.1136/jclinpath-2012-200850] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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12
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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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Cheng H, Zhao S, Jiang S, Lu M, Yan C, Ling J, Zhang Y, Liu Q, Ma N, Yin G, Jerecic R, He Z. The relative atrial volume ratio and late gadolinium enhancement provide additive information to differentiate constrictive pericarditis from restrictive cardiomyopathy. J Cardiovasc Magn Reson 2011; 13:15. [PMID: 21349202 PMCID: PMC3058035 DOI: 10.1186/1532-429x-13-15] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 02/25/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The differentiation of constrictive pericarditis (CP) from restrictive cardiomyopathy (RCM) is often difficult. This study sought to determine the clinical utility of cardiovascular magnetic resonance imaging (CMR) for differentiating both these disorders. METHODS Twenty-three patients with surgically documented CP, 22 patients with RCM and 25 normal subjects were included in the study. CMR yielded information about cardiac morphology, function and tissue characteristics. The left (LA) and right atrial (RA) volume was calculated using the area-length method. The relative atrial volume ratio (RAR) was defined as the LA volume divided by RA volume. Receiver operating characteristic curve analysis was used to test the ability of different variables in differentiating CP from RCM. RESULTS The maximal pericardial thickness in CP patients was significantly larger than in normal subjects and RCM patients. The RA volume index in RCM patients (90.5 ± 35.3 mL/m2) was significantly larger than in CP patients (71.4 ± 15.7 mL/m2, p = 0.006) and normal subjects (38.1 ± 9.0 mL/m2, p < 0.001). The LA volume index in RCM (96.0 ± 37.0 mL/m2) and CP patients (105.6 ± 25.1 mL/m2) was significantly larger than in normal subjects (39.5 ± 9.5 mL/m2, p < 0.001 for all). The RAR in CP patients (1.50 ± 0.29) was significantly larger than in RCM patients (1.12 ± 0.33, p < 0.001) and normal subjects (1.06 ± 0.20, p < 0.001). There were no differences between RCM patients and normal subjects in the RAR (p = 0.452). At a cut-off value of 1.32 for the RAR, the sensitivity was 82.6%, and the specificity was 86.4% in the detection of CP. Septal bounce was identified in 95.7% CP patients, in none of RCM patients and normal subjects. Late gadolinium enhancement (LGE) was present in 31.8% RCM patients and absence in all CP patients and normal subjects. CONCLUSIONS CMR with LGE and RAR can facilitate differentiation of CP from RCM.
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Affiliation(s)
- Huaibing Cheng
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Shihua Zhao
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Shiliang Jiang
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Minjie Lu
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Chaowu Yan
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Jian Ling
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Yan Zhang
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Qiong Liu
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Ning Ma
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Gang Yin
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Renate Jerecic
- MR Research and Development, Siemens Medical Solutions USA, Inc., Chicago, IL, USA
| | - Zuoxiang He
- Department of Nuclear medicine, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
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Velthuis S, Laufer EM, Hofstra L, Winkens MHM. An armored heart in constrictive pericarditis. J Am Coll Cardiol 2009; 53:972. [PMID: 19281928 DOI: 10.1016/j.jacc.2008.11.045] [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] [Received: 10/07/2008] [Revised: 10/17/2008] [Accepted: 11/03/2008] [Indexed: 11/19/2022]
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Affiliation(s)
- B Hott
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Kainuma S, Masai T, Yamauchi T, Takeda K, Ito H, Sawa Y. Primary malignant pericardial mesothelioma presenting as pericardial constriction. Ann Thorac Cardiovasc Surg 2008; 14:396-398. [PMID: 19131929] [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: 09/03/2007] [Accepted: 11/26/2007] [Indexed: 05/27/2023] Open
Abstract
A 55-year-old man with a history of pericardiocentesis for massive pericardial effusion of unknown etiology was admitted to our hospital because of shortness of breath and systemic edema in September 2005. Transthoracic echocardiography demonstrated the massive PE 2 cm in diameter and with several areas of thick hyperrefractile echoes arising from the pericardium. Computed tomography (CT) demonstrated a large mediastinal mass encasing the heart; a pressure of the right ventricle (RV) showed a pattern of dips and plateaus on cardiac catheterization. Pericardiocentesis was attempted, but no fluid could be aspirated. The patient's symptoms progressed day by day despite maximum pharmacological support with catecholamines and diuretics. Surgical treatment was planned to relieve the symptoms and confirm the definitive diagnosis. Pericardiectomy and partial resection of the tumor under cardiopulmonary bypass (CPB) could be performed, and this resulted in a marked relief of symptoms. Histological examination confirmed the malignant pericardial mesothelioma. In conclusion, pericardiectomy and resection of the tumor might be indicated for the relief of symptoms in a critical case presenting as pericardial constriction associated with malignant pericardial mesothelioma.
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Affiliation(s)
- Satoshi Kainuma
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, and Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Zhang LH, Ni C, Guo LL. [Clinical and pathological characteristics of constrictive pericarditis in China]. Zhonghua Xin Xue Guan Bing Za Zhi 2008; 36:812-815. [PMID: 19102863] [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: 05/27/2023]
Abstract
OBJECTIVE To summarize the clinical and pathological characteristics of constrictive pericarditis in China. METHOD Data from 150 patients with constrictive pericarditis who admitted to our hospital from 2000 to 2007 were retrospectively analyzed. RESULTS Constriction pericarditis was detected by echocardiography in 149 out of 150 patients. Pericardial effusion was evidenced in 59.3% patients (89/150). The diagnostic accuracy rate for identifying constrictive pericarditis by echocardiography (98.7%, 107/109) was comparable to that of surgical diagnosis (100%, 109/109). Tuberculosis was the main cause of constrictive pericarditis in this cohort (78.7%, 118/150) including 25 (16.7%) cases with pathological or etiological evidences of tubercular pericarditis, 8 (5.3%) cases with pathologically active tuberculous focus elsewhere in the body, 66 (44.0%) cases with typical clinical tuberculosis manifestation and responded to anti-tubercular therapy and 19 (12.7%) cases with a diagnosis of suspicious tuberculosis. Pericardiectomy was performed in 108 cases and pericardial biopsy and surgical drainage was performed in 1 patient. In hospital death rate was 8.7% (13/150, 4 tubercular patients and 9 non-tubercular). CONCLUSION Tuberculosis is the leading cause of constrictive pericarditis in this cohort and the best diagnosis tool is echocardiography other than pathological and etiological findings in pericardium.
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Affiliation(s)
- Li-Hua Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
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Russell JB, Syed FF, Ntsekhe M, Mayosi BM, Moosa S, Tshifularo M, Smedema JP. Tuberculous effusive-constrictive pericarditis. Cardiovasc J Afr 2008; 19:200-201. [PMID: 18776964] [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: 05/26/2023] Open
Abstract
Infection with Mycobacterium tuberculosis and the human immunodeficiency virus has reached epidemic proportions in South Africa. Cardiac involvement occurs in approximately one per cent of patients suffering from active tuberculosis. This concerns predominantly pericardial involvement, resulting in chronic pericardial effusions, cardiac tamponade and constrictive pericarditis. Effusive-constrictive pericarditis is a clinical haemodynamic syndrome in which constriction by the visceral pericardium occurs in the presence of a tense effusion in a free pericardial space. We present a patient who was diagnosed with this condition, and highlight the value of contrast-enhanced magnetic resonance imaging in demonstrating the underlying structural and functional abnormalities.
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Affiliation(s)
- J B Russell
- Department of Internal Medicine, Groote Schuur Hospital and University of Cape Town, Observatory
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19
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Santos A, Thomas B, Tavares NJ. Pericardial thickening in patients with clinically suspected constrictive pericarditis. Rev Port Cardiol 2008; 27:419-421. [PMID: 18551926] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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20
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Abstract
The human immunodeficiency virus (HIV) epidemic has been associated with an increase in all forms of extrapulmonary tuberculosis including tuberculous pericarditis. Tuberculosis is responsible for approximately 70% of cases of large pericardial effusion and most cases of constrictive pericarditis in developing countries, where most of the world's population live. However, in industrialized countries, tuberculosis accounts for only 4% of cases of pericardial effusion and an even smaller proportion of instances of constrictive pericarditis. Tuberculous pericarditis is a dangerous disease with a mortality of 17% to 40%; constriction occurs in a similar proportion of cases after tuberculous pericardial effusion. Early diagnosis and institution of appropriate therapy are critical to prevent mortality. A definite or proven diagnosis is based on demonstration of tubercle bacilli in pericardial fluid or on histologic section of the pericardium. A probable or presumed diagnosis is based on proof of tuberculosis elsewhere in a patient with otherwise unexplained pericarditis, a lymphocytic pericardial exudate with elevated biomarkers of tuberculous infection, and/or appropriate response to a trial of antituberculosis chemotherapy. Treatment consists of 4-drug therapy (isoniazid, rifampicin, pyrazinamide, and ethambutol) for 2 months followed by 2 drugs (isoniazid and rifampicin) for 4 months regardless of HIV status. It is uncertain whether adjunctive corticosteroids are effective in reducing mortality or pericardial constriction, and their safety in HIV-infected patients has not been established conclusively. Surgical resection of the pericardium is indicated for those with calcific constrictive pericarditis or with persistent signs of constriction after a 6 to 8 week trial of antituberculosis treatment in patients with noncalcific constrictive pericarditis.
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MESH Headings
- AIDS-Related Opportunistic Infections/complications
- AIDS-Related Opportunistic Infections/diagnosis
- AIDS-Related Opportunistic Infections/drug therapy
- AIDS-Related Opportunistic Infections/epidemiology
- AIDS-Related Opportunistic Infections/microbiology
- AIDS-Related Opportunistic Infections/surgery
- Adrenal Cortex Hormones/therapeutic use
- Antitubercular Agents/therapeutic use
- Echocardiography
- Electrocardiography
- Humans
- Mycobacterium tuberculosis
- Pericardial Effusion/drug therapy
- Pericardial Effusion/microbiology
- Pericardial Effusion/pathology
- Pericardial Effusion/surgery
- Pericardiectomy
- Pericardiocentesis
- Pericarditis, Constrictive/drug therapy
- Pericarditis, Constrictive/microbiology
- Pericarditis, Constrictive/pathology
- Pericarditis, Constrictive/surgery
- Pericarditis, Tuberculous/complications
- Pericarditis, Tuberculous/diagnosis
- Pericarditis, Tuberculous/drug therapy
- Pericarditis, Tuberculous/epidemiology
- Pericarditis, Tuberculous/microbiology
- Pericarditis, Tuberculous/surgery
- Treatment Outcome
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Affiliation(s)
- Faisal F Syed
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
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21
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Yamauchi T, Masai T, Takeda K, Kainuma S, Sawa Y, Abe K. Severely calcified constrictive pericarditis simulating a mediastinal tumor and obstructing the right ventricular inflow tract. Ann Thorac Cardiovasc Surg 2007; 13:410-412. [PMID: 18292726] [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: 11/24/2006] [Accepted: 02/12/2007] [Indexed: 05/25/2023] Open
Abstract
We report a rare case of constrictive pericarditis that stimulated a large mediastinal tumor obstructing the right ventricular inflow tract. A 58-year-old woman was referred to our hospital because of a recent increase of dyspnea and facial edema. Computed tomography revealed severely thickened calcification, including a low-density area, presenting as a mediastinal tumor, compressing the right ventricular inflow tract. A complete resection was performed, and her symptoms dramatically improved. Idiopathic constrictive pericarditis was diagnosed pathologically.
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Affiliation(s)
- Takashi Yamauchi
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan
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22
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Teraoka K. [Pericardial fibrosis]. Nihon Rinsho 2007; Suppl 5 Pt 2:431-434. [PMID: 17948718] [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: 05/25/2023]
Affiliation(s)
- Kunihiko Teraoka
- Center for Health Surveillance and Preventive Medicine, Tokyo Medical University
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23
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Affiliation(s)
- H-H Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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24
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Gujral V, López-Candales A, Abdelhadi R, Crock F, Gulyasy B. Constrictive pericarditis: An unusual clinical entity suggested during dobutamine stress echocardiography. Int J Cardiol 2006; 113:e58-61. [PMID: 16797749 DOI: 10.1016/j.ijcard.2006.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 04/28/2006] [Indexed: 11/20/2022]
Abstract
A 44-year-old female presents with disabling dyspnea and is unable to perform a regular treadmill stress test; instead a dobutamine stress echocardiogram is performed and although negative for ischemia reveals a vigorous paradoxical motion of the interventricular septum with dilatation of the inferior vena cava without respiratory variation and an increased diastolic flow signal in the hepatic veins after expiration with the infusion of dobutamine. The diagnosis of constrictive physiology is confirmed with cardiac magnetic resonance imaging (MRI) and right heart hemodynamics and the patient underwent pericardiectomy without complications with resolution of symptoms.
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25
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Ha JW, Ko YG, Choi BW. Images in cardiology. Delayed hyperenhancement of the pericardium by magnetic resonance imaging as a marker of pericardial inflammation in a patient with tuberculous effusive constrictive pericarditis. Heart 2006; 92:494. [PMID: 16537764 PMCID: PMC1860887 DOI: 10.1136/hrt.2005.072348] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 11/04/2022] Open
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26
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Camprubí M, Mercé J, Raventós A. [Pericardial constriction secondary to cholesterol pericarditis]. Rev Esp Cardiol 2006; 59:289-90. [PMID: 16712756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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27
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Meijers BKI, Schalla S, Eerens F, Van Suylen RJ, Broers B, Cheriex EM, Smedema JP. Protein-losing enteropathy in association with constrictive pericarditis. Int J Cardiovasc Imaging 2006; 22:389-92. [PMID: 16502021 DOI: 10.1007/s10554-005-9067-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2005] [Accepted: 12/06/2005] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Björn K I Meijers
- Department of Cardiology, Maastricht University Hospital, Maastricht, The Netherlands.
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28
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Ha JW, Lee JD, Ko YG, Yun M, Rim SJ, Chung N, Cho SH. Images in cardiovascular medicine. Assessment of pericardial inflammation in a patient with tuberculous effusive constrictive pericarditis with 18F-2-deoxyglucose positron emission tomography. Circulation 2006; 113:e4-5. [PMID: 16391161 DOI: 10.1161/circulationaha.105.554139] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 11/16/2022]
Affiliation(s)
- Jong-Won Ha
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
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29
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Ha JW, Chang BC, Choi BW, Chung N, Shim WH, Cho SY, Kim SS. Images in cardiovascular medicine. Constrictive epicarditis as an unusual cause of constrictive physiology: typical presentation with unusual pathology. Circulation 2006; 111:e365-6. [PMID: 15927982 DOI: 10.1161/circulationaha.104.472209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/16/2022]
Affiliation(s)
- Jong-Won Ha
- Division of Cardiology, Yonsei University College of Medicine, Seoul, South Korea.
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30
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Leclair F, Gueffet JP, Baron O, Briec F, Trochu JN, Heymann MF. [A chronic pericardial effusion]. Ann Pathol 2005; 25:143-4. [PMID: 16142168 DOI: 10.1016/s0242-6498(05)86180-2] [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] [Indexed: 10/22/2022]
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31
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Affiliation(s)
- Cindy W Tom
- Mayo Graduate School of Medicine, Mayo Clinic, Rochester, MN, USA.
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32
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Wessely R, Vorpahl M, Schömig A, Klingel K. Late constrictive involvement of the pericardium in a case of previous myocarditis. Cardiovasc Pathol 2005; 13:327-9. [PMID: 15556780 DOI: 10.1016/j.carpath.2004.07.002] [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: 03/17/2004] [Revised: 06/29/2004] [Accepted: 07/08/2004] [Indexed: 10/26/2022] Open
Abstract
Constrictive pericarditis (CP) is a highly relevant disease clinically because pericardiectomy represents the only curative therapeutic approach. Previous cardiac surgery or mediastinal radiation may cause CP, however, infectious agents account for a substantial portion of CP. In this report, we present a patient with previous biopsy-proven myocarditis and positive seroconversion against coxsackievirus B3 without clinical evidence of acute pericardial involvement who developed CP after a prolonged period of time. This suggests that infectious particles primarily infecting the myocardium may lead to chronic inflammatory responses of the pericardium, thus causing CP even at late clinical stages. This case emphasizes the important fact that primary myocarditis may not only cause systolic ventricular impairment but may also induce diastolic dysfunction of the heart, either as restrictive cardiomyopathy or, as in this case, through inflammatory involvement of the pericardium, leading to CP.
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MESH Headings
- Antibodies, Viral/blood
- Diastole
- Enterovirus B, Human/immunology
- Humans
- Male
- Middle Aged
- Myocarditis/complications
- Myocarditis/pathology
- Pericarditis, Constrictive/etiology
- Pericarditis, Constrictive/pathology
- Pericarditis, Constrictive/physiopathology
- Pericarditis, Constrictive/surgery
- Pericardium/pathology
- Pericardium/surgery
- Tomography, X-Ray Computed
- Treatment Outcome
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/pathology
- Ventricular Dysfunction, Left/physiopathology
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Affiliation(s)
- Rainer Wessely
- Deutsches Herzzentrum und 1. Medizinische Klinik, Technische Universität, Munich, Germany.
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33
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Sève P, Stankovic K, Broussolle C. Effectiveness of colchicine in a case of recurrent compressive rheumatoid pericarditis. Rheumatol Int 2005; 25:558-61. [PMID: 15645232 DOI: 10.1007/s00296-004-0572-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2004] [Accepted: 11/13/2004] [Indexed: 10/25/2022]
Abstract
Survival is impaired in rheumatoid pericarditis complicated by cardiac compression by either tamponade or constriction. Conventional therapy with non-steroidal anti-inflammatory agents and glucocorticoids is frequently ineffective in reversing severe cardiac impairment and/or in preventing recurrences. Colchicine, an effective and safe treatment of idiopathic and post-viral pericarditis, has not been studied in rheumatoid pericarditis. We describe the case of a 44-year-old woman with a 1-year history of rheumatoid arthritis who developed rheumatoid pericarditis complicated with tamponade. Pericardiocentesis relieved the symptoms, but pericarditis recurred at a high dose of prednisone of 70 mg/day. Colchicine at a dose of 1 mg/day prevented recurrences and had a significant sparing effect on steroids, which were reduced to 6 mg/day. This is the second case report describing the effectiveness of colchicine therapy in rheumatoid pericarditis complicated with tamponade. These cases suggest that colchicine should be considered in the treatment of rheumatoid pericarditis.
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Affiliation(s)
- Pascal Sève
- Department of Internal Medicine, Hôtel-Dieu, 1 place de l'Hôpital, 69288, Lyon Cedex 02, France
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34
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Abstract
We report a 9-year-old boy with progressive heart failure due to effusive-constrictive pericarditis. The patient was successfully rescued by extensive surgical removal of the thickened pericardium. The histopathological examination revealed degenerative changes of myocardium without significant inflammation, indicating that surgical pericardiectomy should be performed for subacute effusive-constrictive pericarditis before progression to definite constrictive pericarditis.
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Affiliation(s)
- C Suita
- Department of Pediatric Cardiology and Nephrology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan
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35
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Butcovan D, Arsenescu C, Pintilie D, Dabija E, Dabija A, Georgescu GIM. [Cardiac amyloidosis. A case report]. Rev Med Chir Soc Med Nat Iasi 2005; 109:46-9. [PMID: 16607826] [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: 05/08/2023]
Abstract
The paper presents the morphoclinical picture in cardiac amyloidosis to a 50 years old man admitted at Iasi Cardiology Center with progressive chronic cardiac failure, the patient having recent history of restrictive cardiomyopathy. It was made a complete cardiovascular evaluation including the right cardiac catheterization for endomyocardial biopsy. The biopsy specimens were fixed in buffered 10 % formalin, followed by routine paraffin embedding, and were stained with haematoxylin-eosin, elastic Van Gieson and sulphated blue Alcian for amyloid evaluation. The amyloid deposits were evidentiated in the interstitium and into vascular walls of the biopsy, pointing the importance of the morphological exam for amyloidosis diagnosis.
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Affiliation(s)
- Doina Butcovan
- Universitatea de Medicină şi Farmacie Gr T Popa Iaşi, Facultatea de Medicină, Disciplina de Morfopatologie
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36
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Afanasyeva M, Georgakopoulos D, Fairweather D, Caturegli P, Kass DA, Rose NR. Novel model of constrictive pericarditis associated with autoimmune heart disease in interferon-gamma-knockout mice. Circulation 2004; 110:2910-7. [PMID: 15505106 DOI: 10.1161/01.cir.0000147538.92263.3a] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Constrictive pericarditis represents a serious hemodynamic syndrome that may lead to heart failure. Studies of its pathophysiological mechanisms have been impeded by the lack of an animal model. METHODS AND RESULTS Cardiac myosin-induced experimental autoimmune myocarditis in interferon (IFN)-gamma-knockout (KO) mice results in increased cardiac inflammation and development of severe grossly detectable pericarditis. Using in vivo pressure-volume studies, we found that the acute phase of experimental autoimmune myocarditis in IFN-gamma-KO mice was characterized by reduced left ventricular (LV) volumes compared with wild-type mice. The KO mice exhibited a classic restrictive/constrictive phenotype with decreased cardiac output, increased chamber stiffness, preserved ejection fraction, and impaired diastolic filling, characterized by reduced deceleration time and pressure tracings showing the square root sign similar to that observed in clinical cases of constrictive pericarditis. This phenotype was not associated with the severity of myocarditis but correlated with the presence of grossly detectable adhesive pericarditis present only in the KO group and characterized by increased pericardial inflammation and fibrosis. Comparison of IFN-gamma-KO and wild-type mice matched for the severity of myocardial disease further confirmed that pericarditis, and not myocarditis, was responsible for smaller LV volumes, reduced cardiac output, increased cardiac stiffness, and increased peak filling rate adjusted for end-diastolic volumes in KO mice. CONCLUSIONS Autoimmune heart disease in IFN-gamma-KO mice results in increased pericardial inflammation and fibrosis, leading to constrictive phenotype during the acute phase of disease. It represents a novel animal model of constrictive pericarditis.
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Affiliation(s)
- Marina Afanasyeva
- Department of Pathology, Johns Hopkins Medical Intitutions, Baltimore, Md, USA.
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37
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Butany J, El Demellawy D, Collins MJ, Nair V, Israel NS, Woo A, Cusimano RJ. Constrictive pericarditis: case presentation and a review of the literature. Can J Cardiol 2004; 20:1137-44. [PMID: 15457310] [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: 04/30/2023] Open
Abstract
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.
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Affiliation(s)
- Jagdish Butany
- Department of Pathology, Toronto General Hospital/University Health Network, Ontario.
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38
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Bautista-Hernández V, Gutierrez F, Ray VG, Arribas JM, García-Puente J, Casinello N, Arcas R. Constrictive pericarditis due to Coxiella burnetii. Ann Thorac Surg 2004; 78:326-8. [PMID: 15223458 DOI: 10.1016/s0003-4975(03)01361-4] [Citation(s) in RCA: 4] [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] [Accepted: 07/18/2003] [Indexed: 11/27/2022]
Abstract
Q fever is characterized by its clinical polymorphism. Cardiac involvement in acute Q fever is rare. We report a case of pleuro-pericarditis that rapidly evolved to pericardial constriction during an acute episode of Coxiella burnetii infection. Constrictive pericarditis was confirmed by hemodynamic measurements, echocardiography, and magnetic resonance. Indirect immunofluorescence assay revealed positive serology for acute Q fever. The patient underwent a successful pericardiectomy and was given antibiotics. The histopathologic study of the excised pericardium showed C. burnetii in a large cluster of organisms. After a 6-month follow-up period, the individual was asymptomatic.
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Affiliation(s)
- Víctor Bautista-Hernández
- Regional Service of Cardiovascular Surgery, University Hospital Virgen de la Arrixaca, Murcia, Spain.
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39
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Wong R, Durand JB, Luna MA, Couriel DR, Gajewski JL. Images in cardiovascular medicine. Constrictive pericarditis in a patient with relapsed acute myelogenous leukemia after allogeneic bone marrow transplantation. Circulation 2004; 109:e146-9. [PMID: 15007019 DOI: 10.1161/01.cir.0000121315.05592.ce] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Raymond Wong
- Department of Blood and Marrow Transplantation, University of Texas M.D. Anderson Cancer Center, Houston, Tex 77030, USA
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40
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Talreja DR, Edwards WD, Danielson GK, Schaff HV, Tajik AJ, Tazelaar HD, Breen JF, Oh JK. Constrictive pericarditis in 26 patients with histologically normal pericardial thickness. Circulation 2003; 108:1852-7. [PMID: 14517161 DOI: 10.1161/01.cir.0000087606.18453.fd] [Citation(s) in RCA: 228] [Impact Index Per Article: 10.9] [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: 12/24/2022]
Abstract
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.
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Affiliation(s)
- Deepak R Talreja
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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41
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Härle P, Salzberger B, Glück T, Schölmerich J, Müller-Ladner U. Fatal outcome of constrictive pericarditis in rheumatoid arthritis. Rheumatol Int 2003; 23:312-4. [PMID: 13680151 DOI: 10.1007/s00296-003-0300-9] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 08/23/2002] [Accepted: 01/29/2003] [Indexed: 10/26/2022]
Abstract
This is a report of a 39-year-old patient diagnosed with seropositive rheumatoid arthritis at the age of 17. The patient died 2 years after the onset of extra-articular cardiac symptoms. This case demonstrates the devastating course of progressive constrictive pericarditis under sole medical therapy and emphasizes the importance of early radical pericardectomy to avoid progression of disease and secondary complications with fatal outcome. Further, we discuss risk factors, diagnostic caveats, diagnostic tests and therapy of hemodynamically relevant contrictive pericarditis.
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Affiliation(s)
- Peter Härle
- Department of Internal Medicine I, University of Regensburg, Franz-Josef-Strauss-Allee, 11, D-93042, Regensburg, Germany.
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42
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Okcun B, Baran T, Babalik E, Kücükoglu S. Multichamber masses and constrictive pericarditis in Behçet's disease. Clin Exp Rheumatol 2003; 21:S55. [PMID: 14727463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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43
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Bossert T, Rahmel A, Gummert JF, Battellini R, Mohr FW. [Right heart failure following pericarditis constrictiva tuberculosa--urgent surgical treatment]. Zentralbl Chir 2003; 128:573-5. [PMID: 12884144 DOI: 10.1055/s-2003-40816] [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: 10/27/2022]
Abstract
UNLABELLED A 71-year-old male patient presented with a 4-month history of fever, dyspnoea, night sweat, ankle swelling and was admitted to our institution for further investigation due to heart failure (NHYA IV). A posterior-anterior chest radiograph showed an enlarged cardiac silhouette, the lung was without pathological findings; calcifications were not described. Echocardiography revealed a severe diastolic malfunction but no pericardial effusion. In computed tomography, pericardium was thickened. Patient was admitted for further investigations. Heart catheterization revealed a left ventricular ejection fraction of 56 %, a cardiac index of 1.3 ml/min/m2 leading to the diagnosis of severe constrictive pericarditis. The patient underwent an urgent pericardectomy via median sternotomy. Extracorporal circulation was not necessary. The postoperative course was uneventful, heart failure improved to NYHA II. The removed pericardium revealed severe granulomatous pericarditis resulting from infection with acid-resistant bacilli. The diagnosis was confirmed by a positive culture for mycobacterium tuberculosis. The patient was put on anti-TB chemotherapy for one year. 1 year after operation patient is graduated in NYHA class II. CONCLUSION This rare extrapulmonary form of TB can have an insidious or sudden onset. The diagnosis is complicated by non-specific clinical and radiographic findings. Clinical presentation may be the result of the infectious process itself or the pericardial inflammation causing pain, effusion, and hemodynamic effects. In the absence of concurrent extracardiac TB, diagnosis of pericardial TB is difficult. Nevertheless, rapid diagnosis and treatment are crucial to reduce mortality.
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MESH Headings
- Aged
- Diagnosis, Differential
- Heart Failure/diagnosis
- Heart Failure/etiology
- Heart Failure/pathology
- Heart Failure/surgery
- Humans
- Male
- Pericardiectomy
- Pericarditis, Constrictive/complications
- Pericarditis, Constrictive/diagnosis
- Pericarditis, Constrictive/pathology
- Pericarditis, Constrictive/surgery
- Pericarditis, Tuberculous/complications
- Pericarditis, Tuberculous/diagnosis
- Pericarditis, Tuberculous/pathology
- Pericarditis, Tuberculous/surgery
- Pericardium/pathology
- Ventricular Dysfunction, Right/diagnosis
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/pathology
- Ventricular Dysfunction, Right/surgery
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Affiliation(s)
- T Bossert
- Klinik für Herzchirurgie, Universität Leipzig, Herzzentrum.
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Yurchak PM, Deshpande V. Case record of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 2-2003. A 60-year-old man with mild congestive heart failure of uncertain cause. N Engl J Med 2003; 348:243-9. [PMID: 12529466 DOI: 10.1056/nejmcpc020025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Miltényi Z, Gergely L, Illés A. [Chronic pericarditis in Hodgkin disease]. Orv Hetil 2002; 143:2687-9. [PMID: 12501578] [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: 02/28/2023]
Abstract
INTRODUCTION Among late complications of Hodgkin's disease's treatment the cardiovascular complications are important. The incidence of the late onset (later than 48 months) of chronic pericardial disease is from 11 to 50% among patients with Hodgkin's disease with irradiation in the past history. PURPOSE AND METHODS Authors are presenting chronic constrictive pericarditis in a case among late consequences of therapy of Hodgkin's disease. It's difficult to observe and treat, because it's a rarity. RESULTS (CASE REPORT): A male patient, who is 35 year old in the present, developed III/A2 clinical stage, mixed cellularity Hodgkin's disease in 1992. He got combined chemotherapy and irradiation repeated and he came to complete remission. In 1999 he had no symptoms, but the physical examination, routine chest radiography and echocardiography proved pericardial effusion. Apart from the most frequent reasons of pericarditis and pericardial effusion, radiation induced, hypothyroid and primary manifestation of Hodgkin's disease equally arised. After repeated fenestration of the pericardium partial pericardiectomy was necessary. Chronic constrictive pericarditis was proved by the histological evaluation of the pericardial tissue that was probably provoked by the mediastinal irradiation. Since the pericardiectomy he has being well, he had no relapsed and no signs of pericardial fluid was observed. CONCLUSIONS The early recognition and treatment of late complications are possible by the help of the patient's follow-up. These complications of Hodgkin's disease with using of modern radiotherapy apparatus are usually avoided.
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Affiliation(s)
- Zsófia Miltényi
- Debreceni Egyetem Orvos- és Egészségtudományi Centrum, Altalános Orvostudományi Kar, III. sz. Belgyógyászati Klinika
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Pedemonte E, Anichini C, Nesi G, Orsi A, Tozzini S, Gori F. Constrictive pericarditis associated with hydrops fetalis. Ital Heart J 2002; 3:529-31. [PMID: 12407850] [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: 02/27/2023]
Abstract
We report a rare case of constrictive pericarditis coexistent with a unique heart malformation in a fetus. Cardiac abnormalities, possibly due to a transplacental viral infection, were responsible for severe hydrops fetalis.
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48
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Abstract
An 18-year old woman presented with progressive dyspnea and cough. Physical examination revealed decreased breath sounds at the left hemithorax and distant heart sounds with no murmurs or rub. Electrocardiogram revealed low voltage. Chest X-ray showed unilateral left-sided pleural effusion with no cardiomegaly. Transthoracic echocardiogram showed thickened pericardium localized throughout the left ventricle impairing the diastolic filling. Doppler waveforms were suggestive of localized constrictive pericarditis. A computerized tomographic scan of the chest confirmed the presence of unilateral pleural effusion with thickened pericardium surrounding the left ventricle. The patient's symptoms and signs were related to localized constrictive pericarditis and improved following surgery.
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Affiliation(s)
- Ilyas Akdemir
- Department of Cardiology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey.
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Abstract
Acute pericarditis has been described as an extraintestinal manifestation of inflammatory bowel disease (IBD), as well as a consequence of IBD treatment, specifically sulfasalazine and mesalamine. Until now, there have been no reported cases of constrictive pericarditis associated with IBD or its treatment. A 37-year-old woman with a 24-year history of chronic ulcerative colitis (CUC) presented with a 3-month history of fevers, palpitations, dyspnea, syncope, and retrosternal chest pain. Two weeks before symptoms, she had initiated oral mesalamine for an ongoing CUC flare. Physical examination suggested constrictive pericarditis. An echocardiogram revealed a thickened pericardium with a nearly circumferential fibrinous effusion, with Doppler confirming diastolic compromise. The patient proceeded to radical pericardectomy. Pathological examination showed grossly hemorrhagic acute and chronic pericarditis, with cultures and cytology negative. To date, only 104 cases of IBD with acute pericarditis have been reported, with fewer than 10 cases of mesalamine-induced acute pericarditis reported. This is the first reported case of constrictive pericarditis related to IBD or its treatment. Although our patient may have had IBD-associated constrictive pericarditis, her mesalamine use raises the possibility of a drug-induced constrictive pericarditis.
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Affiliation(s)
- Amy S Oxentenko
- Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, USA
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Ha JW, Oh JK, Ling LH, Nishimura RA, Seward JB, Tajik AJ. Annulus paradoxus: transmitral flow velocity to mitral annular velocity ratio is inversely proportional to pulmonary capillary wedge pressure in patients with constrictive pericarditis. Circulation 2001; 104:976-8. [PMID: 11524387 DOI: 10.1161/hc3401.095705] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.6] [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: 11/16/2022]
Abstract
BACKGROUND The early diastolic velocity of the mitral annulus (E') is reduced in patients with diastolic dysfunction and increased filling pressures. Because transmitral inflow early velocity (E) increases progressively with higher filling pressures, E/E' has been shown to have a strong positive relationship with pulmonary capillary wedge pressure (PCWP) and left ventricular end-diastolic pressure. However, previous studies have primarily involved patients without a pericardial abnormality. In constrictive pericarditis (CP), E' is not reduced, despite increased filling pressures. This study evaluated the relationship between E/E' and PCWP in patients with CP. METHODS AND RESULTS We studied 10 patients (8 men; mean age, 64+/-7 years) with surgically confirmed CP. Doppler echocardiography was performed to measure early and late diastolic transmitral flow velocities. Tissue Doppler echocardiography was performed to measure E'. PCWP was measured with right heart catheterization. All patients were in sinus rhythm. Mean E and E' were 91+/-15 cm/s and 11+/-4 cm/s, respectively. Mean PCWP was 25+/-6 mm Hg. E' was positively correlated with PCWP (r=0.69, P=0.027). There was a significant inverse correlation between E/E' and PCWP (r=-0.74, P=0.014). Despite high left ventricular filling pressures, E/E' (mean, 9+/-4) was <15 in all but 1 patient. CONCLUSIONS Paradoxical to the positive correlation between E/E' and PCWP in patients with myocardial disease, an inverse relationship was found in patients with CP.
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Affiliation(s)
- J W Ha
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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