Importance of Imaging Methods for Diagnosing Constrictive Pericarditis Versus Restrictive Cardiomyopathy

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.

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Constrictive Pericarditis and Restrictive Cardiomyopathy

The ESC Textbook of Cardiovascular Imaging ◽

10.1007/978-1-84882-421-8_27 ◽

2010 ◽

pp. 501-519

Author(s):

Frank Rademakers

Keyword(s):

Constrictive Pericarditis ◽

Restrictive Cardiomyopathy

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Diseases of the Pericardium, Cardiac Tumors, and Cardiac Trauma

10.2310/7900.1025 ◽

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.

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Constrictive Pericarditis and Restrictive Cardiomyopathy

Diagnosis and Management of Adult Congenital Heart Disease ◽

10.1016/b978-0-7020-3426-8.00058-7 ◽

2011 ◽

pp. 430-437

Author(s):

Pedro T. Trindade ◽

Folkert J. Meijboom

Keyword(s):

Constrictive Pericarditis ◽

Restrictive Cardiomyopathy

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The pericardium and pericardial disease

Practical Perioperative Transoesophageal Echocardiography ◽

10.1093/med/9780198759089.003.0016 ◽

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.

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