Constrictive chronic pericarditis in children

2001 ◽  
Vol 11 (2) ◽  
pp. 210-213 ◽  
Author(s):  
S M A Gomes Ferreira ◽  
A Gomes Ferreira ◽  
A do Nascimento Morais ◽  
W Siriano Paz ◽  
F A Alves Silveira
Keyword(s):  
Constrictive Pericarditis ◽  
Diastolic Pressure ◽  
Venous Pressure ◽  
Restrictive Cardiomyopathy ◽  
Cardiac Catheterisation ◽  
Refractory Ascites ◽  
Resonance Imaging ◽  
Pericardial Disease ◽  
Mitral Inflow ◽  
Clinical Background

Constrictive pericarditis is a uncommom disease in children. We have now encountered pericardial thickening as the cause of severe constrictive physiology in two patients, one also having haemodynamic features of restrictive cardiomyopathy. Both patients, who had refractory ascites and evidence of increased systemic venous pressure, underwent Doppler echocardiography, cardiac catheterisation, and magnetic resonance imaging. Resonance imaging failed to show any thickning of the pericardium, but cardiac catheterisation revealed diastolic equalisation of pressures in all four chambers, with only mild elevation of pulmonary pressure in the first patient, but nearly equalisation of diastolic pressure, and a very high pulmonary arterial pressure with a difference of 7 mm Hg between the end diastolic pressures in the two ventricles in the second patient. Doppler revealed a restrictive pattern of mitral inflow, with high E and small A velocities and a short deceleration time. The clinical background did not suggest pericardial disease in either of the patients. We conclude that a careful search is needed to uncover constrictive pericarditis when there is no previous disease which may suggest late pericardial constriction. The haemodynamic features of restrictive cardiomyopathy can co-exist with pericardial restriction, and differentiation between the two entities is critical in view of the diverse management and prognosis of the two conditions.

Abstract 1759: A 27 year-old Man from ’the Valley’ with Shortness of Breath

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Jennifer E Ho ◽  
Yerem Yeghiazarians
Keyword(s):  
Lower Extremity ◽  
Cardiac Catheterization ◽  
Constrictive Pericarditis ◽  
Venous Pressure ◽  
Restrictive Cardiomyopathy ◽  
Left Ventricular ◽  
Shortness Of Breath ◽  
Significant Past Medical History ◽  
Valley Fever ◽  
Mitral Inflow

A 27 year-old man with no significant past medical history was admitted with shortness of breath and subjective fevers. He was diagnosed with Valley fever based on pulmonary infiltrates on chest x-ray and elevated Coccidiomycosis immitis IgG and IgM titers and was treated with antifungal therapy. He subsequently developed worsening dyspnea, orthopnea, and lower extremity swelling. On exam his jugular venous pressure was elevated and he had bilateral pleural effusions, lower extremity edema, and a positive Kussmaul sign. The electrocardiogram showed sinus tachycardia with diffuse T-wave inversions. Echocardiography demonstrated thickened adhesive pericardium, exaggerated respirophasic variation of the tricuspid and mitral inflow Doppler patterns and a prominent septal bounce. Cardiac MRI showed markedly thickened enhancing pericardium with an associated small pericardial effusion and prominent septal bounce. There was no delayed enhancement to suggest myocarditis. Cardiac catheterization showed equalization of diastolic pressures in all four chambers, low cardiac output, and simultaneous right and left ventricular pressures showed respirophasic discordance suggestive of increased ventricular interdependence. All of the above findings were consistent with constrictive pericarditis in the setting of disseminated coccidioidomycosis, and the patient underwent urgent surgical pericardiectomy with improvement in his symptoms. Pathology specimens demonstrated fungal spherules and active inflammation consistent with Coccidiomycosis immitis infection of the pericardium. This case illustrates the multi-disciplinary diagnostic approach that is often needed to distinguish constrictive pericarditis from restrictive cardiomyopathy. It highlights classic features of constrictive physiology seen on imaging and cardiac catheterization in a unique case of fungal pericarditis. Pericardial involvement in disseminated coccidioidomycosis is rare, and constrictive pericarditis treated with pericardiectomy has been described in only two prior cases in the literature.

scholarly journals Surgical Treatment of Constrictive Pericarditis

2017 ◽  
Vol 44 (2) ◽  
pp. 101-106 ◽  
Author(s):  
Burak Can Depboylu ◽  
Parmeseeven Mootoosamy ◽  
Nicola Vistarini ◽  
Ariane Testuz ◽  
Ismail El-Hamamsy ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Diastolic Dysfunction ◽  
Constrictive Pericarditis ◽  
Inflammatory Process ◽  
Symptomatic Relief ◽  
Restrictive Cardiomyopathy ◽  
Diastolic Filling ◽  
Resonance Imaging ◽  
Chronic Inflammatory Process ◽  
Myocardial Atrophy

Constrictive pericarditis is the final stage of a chronic inflammatory process characterized by fibrous thickening and calcification of the pericardium that impairs diastolic filling, reduces cardiac output, and ultimately leads to heart failure. Transthoracic echocardiography, computed tomography, and cardiac magnetic resonance imaging each can reveal severe diastolic dysfunction and increased pericardial thickness. Cardiac catheterization can help to confirm a diagnosis of diastolic dysfunction secondary to pericardial constriction, and to exclude restrictive cardiomyopathy. Early pericardiectomy with complete decortication (if technically feasible) provides good symptomatic relief and is the treatment of choice for constrictive pericarditis, before severe constriction and myocardial atrophy occur. We describe our surgical approach to constrictive pericarditis, summarize our results in 93 patients, and provide a brief overview of the literature.

Diseases of the Pericardium, Cardiac Tumors, and Cardiac Trauma

2016 ◽  
Author(s):  
Terrence D. Welch ◽  
Kyle W Klarich ◽  
Jae K. Oh
Keyword(s):  
Pericardial Effusion ◽  
Constrictive Pericarditis ◽  
Restrictive Cardiomyopathy ◽  
Left Ventricular ◽  
Cardiac Tumors ◽  
Management Options ◽  
Acute Pericarditis ◽  
Pericardial Disease ◽  
Cardiac Trauma ◽  
Pulsed Wave Doppler

The pericardium consists of a fibrous sac and a serous membrane. Because of its simple structure, the clinical syndromes involving the pericardium are relatively few but vary substantially in severity. Cardiac tumors may be either primary or secondary and either benign or malignant, with attachment sites throughout the endocardium. Cardiovascular trauma should be suspected in all patients with chest injuries or severe generalized trauma. Cardiovascular injury may be either blunt or penetrating. This review covers pericardial disease, cardiac tumors, and cardiovascular trauma. Figures show an electrocardiogram in acute pericarditis; acute pericarditis with delayed gadolinium enhancement of the pericardium shown with cardiac magnetic resonance imaging; underlying cause of pericardial effusion requiring pericardiocentesis; pericardial pressure-volume curves; large pericardial effusion with swinging motion of the heart resulting in electrical alternans; typical pulsed-wave Doppler pattern of tamponade; underlying causes of constrictive pericarditis in patients undergoing pericardiectomy; pericardial calcification seen on a chest radiograph; thickened pericardium; typical pulsed-wave Doppler pattern of constrictive pericarditis; typical mitral annular tissue velocities in constrictive pericarditis; a diagnostic algorithm for the echocardiographic diagnosis of constrictive pericarditis; simultaneous right ventricular and left ventricular pressure tracings in restrictive cardiomyopathy; computed tomographic scan showing inflammatory constrictive pericarditis; systolic and diastolic transesophageal echocardiographic images of a large left atrial myxoma attached to the atrial septum; a decision tree of management options for patients with suspected papillary; transesophageal echocardiographic examples of aortic valve, mitral valve, left ventricular outflow tract, and tricuspid valve papillary fibroelastomas; and transesophageal short-axis view of the descending thoracic aorta in a hypotensive patient after a motor vehicle accident. The table lists tamponade versus constriction versus restrictive cardiomyopathy. This review contains 18 highly rendered figures, 1 table, and 77 references.

The pericardium and pericardial disease

2018 ◽  
Author(s):  
David Sidebotham ◽  
Alan Merry ◽  
Malcolm Legget ◽  
Gavin Wright
Keyword(s):  
Pericardial Effusion ◽  
Constrictive Pericarditis ◽  
Restrictive Cardiomyopathy ◽  
Transoesophageal Echocardiography ◽  
Pericardial Tamponade ◽  
Acute Pericarditis ◽  
Pericardial Disease ◽  
Mechanically Ventilated ◽  
Spectral Doppler ◽  
Echocardiographic Assessment

Chapter 16 is a new chapter from earlier editions of Practical Perioperative Transoesophageal Echocardiography. It provides a short summary on the echocardiographic assessment of the normal pericardium and on pericardial disease. The characteristic TOE features of pericardial pathology (cysts, acute pericarditis, pericardial effusion, pericardial tamponade, and constrictive pericarditis) are reviewed. In particular, pericardial constriction is discussed in detail, including outlining the features that distinguish pericardial constriction from restrictive cardiomyopathy. Wherever possible, the spectral Doppler abnormalities associated with pericardial constriction and pericardial tamponade are discussed with reference to patients who are mechanically ventilated.

Pericardial disease

2016 ◽  
Author(s):  
Bernard Paelinck ◽  
Aleksandar Lazarević ◽  
Pedro Gutierrez Fajardo
Keyword(s):  
Differential Diagnosis ◽  
Pleural Effusion ◽  
Pericardial Effusion ◽  
Constrictive Pericarditis ◽  
Restrictive Cardiomyopathy ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Two Dimensional ◽  
Pericardial Disease ◽  
Pericardial Diseases

Echocardiography is the cornerstone for the diagnosis of pericardial disease. It is a portable technique allowing morphological and functional multimodality (M-mode, two-dimensional, Doppler, and tissue Doppler) imaging of pericardial disease. In addition, echocardiography is essential for differential diagnosis (pericardial effusion vs pleural effusion, constrictive pericarditis vs restrictive cardiomyopathy) and allows bedside guiding of pericardiocentesis. This chapter describes normal pericardial anatomy and reviews echocardiographic features of different pericardial diseases and their pathophysiology, including pericarditis, pericardial effusion, constrictive pericarditis, pericardial cyst, and congenital absence of pericardium.

Pericardiectomy: Prompt Surgical Management of Constrictive Pericarditis

2015 ◽  
Vol 17 (6) ◽  
pp. 319 ◽  
Author(s):  
Kamran Y. Inamdar ◽  
Maimaiti Aikebaier ◽  
Lijunhong Li ◽  
Hi Abudunaibi ◽  
Mulati Abudureheman
Keyword(s):  
Constrictive Pericarditis ◽  
Heart Function ◽  
Venous Pressure ◽  
Median Sternotomy ◽  
Postoperative Mortality ◽  
Restrictive Cardiomyopathy ◽  
Clinical Findings ◽  
X Rays ◽  
Diagnostic Challenge ◽  
Diagnostic Modalities

<p><b>Background:</b> Constrictive pericarditis is a slow progressive fibrosis of the pericardium leading to a variety of symptoms and signs over time. The disease poses a diagnostic challenge; restrictive cardiomyopathy and other syndromes associated with right-sided pressure abnormalities share similar symptoms and clinical findings. Pericardiectomy is considered the treatment of choice for constrictive pericarditis. Here we studied the effects of total radical pericardiectomy on hemodynamics in 37 patients diagnosed with constrictive pericarditis.</p><p><b>Methods:</b> Between 2005 and 2012 thirty-seven patients, 31 males and 6 females, age range 15 to 69 years, underwent total pericardiectomy for constrictive pericarditis. Diagnosis was made on the basis of clinical, pathological and diagnostic modalities-ECG, x-rays, magnetic resonance imaging, computed tomography and echocardiogram. The surgical approach was median sternotomy and surgery was conducted without cardiopulmonary bypass.</p><p><b>Results:</b> Postoperative outcomes showed overall improvement in the majority of patients. Hemodynamics-stroke volume, cardiac output, ejection fraction, central venous pressure-were all measurably improved postoperatively. There was no postoperative mortality.</p><p><b>Conclusion:</b> Radical pericardiectomy is a demonstrably useful procedure for correction of hemodynamic abnormalities and improvement of overall heart function in symptomatic patients with constrictive pericarditis.</p>

scholarly journals A Rare Constrictive Pericarditis with Complete Separation between the Visceral and Parietal Pericardium: A Case Report

2020 ◽  
Vol 23 (4) ◽  
pp. E546-E548
Author(s):  
Qianhui Sun ◽  
Liang Ma ◽  
Peng Teng
Keyword(s):  
Case Report ◽  
Constrictive Pericarditis ◽  
Preoperative Evaluation ◽  
Venous Pressure ◽  
Abdominal Distension ◽  
Complete Separation ◽  
Lower Extremity Edema ◽  
Chronic Liver Diseases ◽  
Pericardial Disease ◽  
Parietal Pericardium

Background: Pericarditis is the most common form of pericardial disease, while constrictive pericarditis is challenging in diagnosis and is easily overlooked. Case report: A 30-year-old female presented with abdominal distension and mild lower extremity edema for 3 months. The patient was initially suspected of having cirrhosis caused by Wilson Disease. Following liver biopsy and multiple investigation, thickened, calcified pericardium was detected by echocardiography and chest computed tomography. The patient was finally diagnosed with chronic constrictive pericarditis and received pericardiectomy. Intraoperatively, we found that the heart was entirely constricted by the thickened and calcified visceral pericardium, which was completely separated from the parietal pericardium. The patient received successful pericardiectomy and had relief of symptoms after surgery. Conclusion: Patients with constrictive pericarditis may present with symptoms similar to that of chronic liver diseases, which makes it difficult and complicated for diagnosis. This case highlights the importance of comprehensive preoperative evaluation and maintaining clinical suspicion of pericarditis in patients with features of elevated systemic venous pressure. In addition, constrictive pericarditis with complete separation between visceral and parietal pericardium has seldom been reported.

scholarly journals A rare cause of ascites in a renal transplant recipient

2018 ◽  
pp. bcr-2018-226532
Author(s):  
Ganesh Kasinadhuni ◽  
Jasmine Sethi ◽  
Darshan Krishnappa ◽  
Yash Paul Sharma
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Transplant Recipient ◽  
Constrictive Pericarditis ◽  
Heart Sound ◽  
Venous Pressure ◽  
Hepatic Veins ◽  
Jugular Venous Pressure ◽  
Mitral Inflow ◽  
Characteristic Features

Thirty-five-year-old man, underwent renal transplantation 4 years back and was doing well. He now presented with complaints of ascites with engorged neck veins and dyspnoea on exertion for last 6 months. Examination showed elevated jugular venous pressure with two prominent descents, high pitched diastolic heart sound (pericardial knock). Echocardiography showed characteristic features of thickened pericardium, septal bounce, expiratory flow reversal in hepatic veins and phasic variation of mitral inflow, suggestive of constrictive pericarditis. The patient was started on empirical antitubercular therapy and diuretics. The patient symptomatically improved, but in view of persisting constrictive physiology he was planned for pericardiectomy.

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