ABSTRACT
A pericardite constritiva (PC) é uma condição na qual a cicatrização e perda de elasticidade do pericárdio resultam em enchimento ventricular prejudicado, disfunção diastólica e insuficiência cardíaca direita. O diagnóstico dessa patologia é desafiador, sendo frequente a necessidade de técnicas de imagem multimodal, dentre as quais a ecocardiografia representa a modalidade de imagem inicial para a avaliação diagnóstica, além de permitir a diferenciação da PC da cardiomiopatia restritiva (CMR) e outras condições que mimetizam constrição. (AU)
Constrictive pericarditis (CP) is a condition in which scarring and loss of elasticity of the pericardium result in impaired ventricular filling, diastolic dysfunction, and right heart failure. The diagnosis of this pathology is challenging, with frequent need for multimodal imaging techniques, among which echocardiography represents the initial imaging modality for the diagnostic evaluation, in addition to allowing the differentiation of CP from restrictive cardiomyopathy (RCM) and other conditions that mimic constriction. (AU)
Subject(s)
Humans , Adolescent , Aged , Aged, 80 and over , Young Adult , Pericarditis, Constrictive/physiopathology , Pericarditis, Constrictive/diagnostic imaging , Pericardium/abnormalities , Heart Failure/etiology , Pericardium/anatomy & histology , Tuberculosis/complications , Cardiomyopathy, Restrictive/diagnosis , Echocardiography/methods , Magnetic Resonance Spectroscopy/methods , Tomography, X-Ray Computed/methodsABSTRACT
Polyserositis is defined as chronic inflammation of several serous membranes with effusions in serous cavities like Pericardial, Pleural and Peritoneal membranes, resulting in fibrous thickening of the serous membranes and sometimes constrictive pericarditis. There are various causes of polyserositis which include autoimmune diseases, neoplasia, endocrine diseases, drug � related causes and infectious diseases such as tuberculosis. Polyserositis in disseminated TB is a very rare presentation. Diagnosis is often delayed due to the non-specific presentation like polyserositis and its unusual nature. We herewith report a rare case of TB polyserositis, involving pleura, pericardium and peritoneum.
ABSTRACT
We report a case of constrictive pericarditis due to extrapulmonary tuberculosis associated with Human Immuno-deficiency Virus, complicated by cardiac tamponade that required surgical intervention in a drug user patient. The importance of early diagnosis and management is widely highlighted
El artículo presenta un caso de pericarditis constrictiva secundaria a tuberculosis extrapulmonar en un paciente con prueba positiva para virus de inmunodeficiencia humana (VIH) consumidor de sustancias psicoactivas, quien durante la hospitalización desarrolló un taponamiento cardíaco con requerimiento de intervención quirúrgica. Se plantea la discusión de la importancia de cada una de las pruebas solicitadas y el manejo adecuado en pacientes con dichas patologías
O artigo apresenta um caso de pericardite constritiva secundária à tuberculose extrapulmonar em paciente com teste positiva para vírus da imunodeficiência humana (HIV) e usuário de substâncias psicoativas que, durante a internação, desenvolveu tamponamento cardíaco com necessidade de intervenção cirúrgica. Discute-se a importância de cada um dos exames solicitados e o manejo ade-quado de pacientes com essas patologias
Subject(s)
Pericarditis, Constrictive , Cardiac Tamponade , HIV , Immunosuppression Therapy , Tuberculosis, ExtrapulmonaryABSTRACT
ABSTRACT Introduction: The mainstay of the treatment of constrictive pericarditis is pericardiectomy. However, surgery is associated with high early morbidity and mortality and low long-term survival. The aim of this study is to describe our series of pericardiectomies performed over 30 years. Methods: A descriptive, observational, and retrospective analysis of all pericardiectomies performed at the Institute of Cardiology and Cardiovascular Surgery of the Favaloro Foundation was performed. Results: A total of 45 patients underwent pericardiectomy between June 1992 and June 2022, mean age was 52 years (standard deviation ± 13.9 years), and 73.3% were men. Idiopathic constrictive pericarditis was the most prevalent (46.6%). The variables significantly associated with prolonged hospitalization were preoperative advanced functional class (incidence of 38.4%, P<0.04), persistent pleural effusion (incidence of 81.8%, P<0.01), and although there was no statistical significance with the use of cardiopulmonary bypass, a trend in this association is evident (P<0.07). We found that 100% of the patients with an onset of symptoms greater than six months had a prolonged hospital stay. In-hospital mortality was 6.6%, and 30-day mortality was 8.8%. The preserved functional class is 17 times more likely to improve their symptomatology after pericardiectomy (odds ratio 17, 95% confidence interval 2.66-71; P<0.05). Conclusion: Advanced functional class at the time of pericardiectomy is the variable most strongly associated with mortality and prolonged hospitalization. Onset of the symptoms greater than six months is also a poor prognostic factor mainly associated with prolonged hospitalization; based on these data, we strongly support the recommendation of early intervention.
ABSTRACT
A 40-year-old male patient presented with an unexplained pericardial effusion and was treated with antituberculosis therapy. This patient showed a transient improvement, but then progressively worsened to develop constrictive pericarditis, multiple plasma chamber effusions, and venous thrombosis. The patient was transferred to Zhongshan Hospital, Fudan University. Through a pleural histopathological biopsy, this patient was diagnosed with pleural mesothelioma and secondary malignant tumor of the pericardium. Later, clinical the manifestations of patient progressed rapidly, resulting in the death of the patient. Mesothelioma is a very rare group of malignant tumors originating from the pleura and other tissues. Patients are mostly advanced at the time of initial diagnosis, with limited treatments and short median survival. It is important to strengthen the understanding of mesothelioma, pay attention to all medical and technical examinations, especially dynamic follow-up of changes in the disease for early diagnosis of this disease.
ABSTRACT
We report the successful treatment of a rare case of chronic expanding hematoma and visceral pericardium thickening constrictive pericarditis with no history of trauma or surgery. A 70-year-old woman, who had no history of trauma or surgery was admitted for exertional dyspnea. An echocardiographic study demonstrated a mass located anterior to the right ventricle that severely compressed the right ventricle toward the ventricular septum. Enhanced chest computed tomography demonstrated pericardial calcification and a 125-mm heterogeneous mass in the middle mediastinum. A mosaic pattern was seen on T1, T2-weighted magnetic resonance imaging. Surgical resection of the mass and removal of the visceral pericardium were planned to treat heart failure and to confirm the diagnosis of the mass. The mass was old degenerated coagula. Histopathological examination confirmed the diagnosis of chronic expanding hematoma. The postoperative course was uneventful. There has been no sign of recurrence 19 months after the operation.
ABSTRACT
A 67-year-old man developed the recurrence of postoperative constrictive pericarditis. He had two operation histories : the one was CABG for old myocardial infarction and the other was pericardiectomy for postoperative pericarditis at 57 and 59 years old respectively. Both operations were performed in our hospital. We used an ePTFE sheet for covering the heart in the pericardiectomy. The course post operation was good, but eight years after the pericardiectomy, he had abdominal distension and leg edema. Detailed studies revealed a recurrence of constrictive pericarditis, and reoperation was performed. The re-operative finding showed thickened sclerotic tissues on both sides of an ePTFE sheet which was applied to the cardiac surface during the previous surgery. No abnormal tissue was detected where the ePTFE sheet was not applied. The ePTFE sheet and the sclerotic tissues were removed under cardiopulmonary bypass support, and then diastolic dysfunction improved dramatically. His chest was closed without applying an ePTFE sheet. His post-operative course was uneventful and he was discharged on the 20th postoperative day. The ePTFE sheet was highly suspected as a cause of the recurrent constrictive pericarditis. An ePTFE sheet-induced constrictive pericarditis should be considered as one of the postoperative complications even in the mid and long-term period. The ePTFE sheet is useful for preventing heart or vascular injury when we perform resternotomy, but in rare cases, there is some possibility of association with a risk of pericarditis.
ABSTRACT
We report a case of a 64-year-old woman with a history of radiation therapy for breast cancer 27 years ago who developed malignant pericardial mesothelioma. Since 3 years ago, the recurrent bloody pericardial effusion was getting worse, which caused general edema and nocturnal dyspnea. She had a thickened pericardium and the right ventricular pressure curve showed a dip-and-plateau pattern. We diagnosed constrictive pericarditis and performed a pericardiectomy and waffle procedure on the thickened epicardium without cardiopulmonary bypass. The post-operative histology confirmed malignant pericardial mesothelioma and she died on the 17th postoperative day. Pericardial malignant mesothelioma is a rare disorder but very aggressive. This fatal disease may be considered in a patient with recurrent bloody pericardial effusion who has a history of thoracic radiation therapy.
ABSTRACT
Resumen La pericarditis constrictiva y la miocardiopatía restrictiva son enfermedades raras caracterizadas por síntomas de insuficiencia cardíaca congestiva. El objetivo de este estudio es mostrar el diagnóstico diferencial de estas dos patologías, mediante strain auricular y establecer su correlación con la histopatología de corazones correspondientes. Se analizan 2 casos clínicos representativos de cada una de estas patologías. Se analizan sus presentaciones clínicas, los datos ecocardiograficos y en ambos casos se realizaron biopsias endomiocardicas con lo cual se presenta la correlación histológica. El strain auricular permitió evaluar la afección de las aurículas, consideramos que el strain auricular disminuido podría estar relacionado con la presencia de fibrosis.
Abstract Histopathology and Atrial Strain in Constrictive Pericarditis and restrictive cardiomyopathy Constrictive pericarditis and restrictive cardiomyopathy are rare diseases characterized by congestive heart failure symptoms. The aim of this study is to show the differential diagnosis of these two pathologies using strain and to establish their correlation with histopathology of the corresponding hearts. Two representative clinical cases of each of these pathologies are analyzed. Their clinical presentations, echocardiographic data, and endomyocardial biopsies were performed in both cases, thus presenting the histological correlation. Atrial strain allowed us to evaluate the affection of the atria, we consider that decreased atrial strain could be related to the presence of fibrosis.
Subject(s)
Humans , Male , Middle Aged , Pericarditis, Constrictive/diagnosis , Cardiomyopathy, Restrictive/diagnosis , Costa RicaABSTRACT
A 36-year-old man underwent direct closure of an atrial septal defect through median sternotomy at the age of 14. He also underwent a mitral valve replacement with tricuspid annuloplasty using the same approach at the age of 18. The patient also presented with pretibial edema and congestive liver disease at the age of 27 and the pretibial edema progressed at the age of 35. Hypoalbuminemia (TP ; 3.6 g/dl, Alb ; 1.6 g/dl) was also observed. Further examinations were performed, which revealed that the right ventricular pressure curve presented a dip and plateau pattern by cardiac catheterization. Computed tomography of the chest additionally revealed thickened and calcified pericardium in the left ventricle. Abdominal scintigraphy showed tracer accumulation in the transverse colon hepatic flexure 4 h after intravenous administration of technetium-99m-labelled human serum albumin. The patient was diagnosed with a protein-losing gastroenteropathy caused by constrictive pericarditis. He underwent pericardiectomy via left anterior thoracotomy without cardiopulmonary bypass. No complications were present after the surgery, and he was discharged after 46 postoperative days. Following his discharge from the hospital, the pretibial edema disappeared, and serum albumin levels gradually increased and normalized within 3 months after the surgery (TP 7.1 g/dl, Alb 4.2 g/dl).
ABSTRACT
We report a surgical case of severe tricuspid regurgitation with hemodynamic features mimicking constrictive pericarditis. A catheterization study showed a dip and plateau pattern of right and left ventricular pressure. Intraoperative finding : the pericardium was not adherent to the epicardial wall. The tricuspid regurgitation was successfully repaired by cleft suture and tricuspid annuloplasty. After surgery, the echocardiographic features mimicking constrictive pericarditis were normalized.
ABSTRACT
A 70-year-old woman who was bedridden because of right hemiplegia attributable to a history of cerebral hemorrhage underwent surgical thrombectomy for pulmonary embolism four years previously. Symptoms of heart failure appeared one year previously, and she was diagnosed with constrictive pericarditis and had been treated with medication by a previous doctor. In the current situation, she visited the previous doctor with the chief complaint of fever, and pericardial effusion was observed on echocardiography. Cardiac tamponade was suspected and she was transferred to our hospital. She was then diagnosed with purulent pericarditis because purulent fluid was observed during pericardiocentesis drainage. Bacteroides fragilis was isolated from the culture of the abscess. The abscess was resistant to conservative antibiotic therapy ; therefore, we performed a pericardiotomy with a left small thoracotomy. The pleural effusion was found to be negative for culture and the patient exhibited a good postoperative course. Purulent pericarditis is refractory with poor prognosis. An appropriate surgical procedure must be chosen considering the patient's activities of daily living. Here, we report a surgical case wherein we chose the left thoracotomy approach and achieved positive results.
ABSTRACT
Chronic constrictive pericarditis is a condition marked by scarred and inelastic pericardium with excessive fibrous tissue and calcium. Here, we report a case of Egg-Shell like calcification in a 30-year-old young adult diagnosed with chronic constrictive pericarditis. The patient was successfully managed with very good prognosis post-pericardiectomy.
ABSTRACT
La pericarditis constrictiva es una entidad poco frecuente en pediatría, en la cual existe una limitación para la diástole cardíaca por fibrosis del pericardio. El origen etiopatogénico de esta patología es múltiple, encontrándose en primer lugar, la pericarditis constrictiva idiopática y, en segundo, la infección por Mycobacterium tuberculosis. El diagnóstico constituye un desafío clínico, ya que requiere de un alto grado de sospecha. Suele presentarse de forma oligosintomática. La presencia de edema, ascitis y alteración de la función hepática suele orientar el estudio hacia una enfermedad hepática primaria. Una cuidadosa historia clínica y examen físico, junto con estudios por imágenes adecuados, constituyen las piedras angulares del diagnóstico. El tratamiento quirúrgico realizado de forma oportuna resulta curativo en la gran mayoría de los pacientes. Se presenta el caso de un paciente de 16 años que inicia estudios por hallazgo de hepatomegalia asociada a disnea grado 1-2 en un control de salud habitual.
Constrictive pericarditis is a rare entity in pediatrics in which there is a limitation for cardiac diastole due to fibrosis of the pericardium. The etiopathogenic origin of this pathology is multiple, finding idiopathic constrictive pericarditis firstly and Mycobacterium tuberculosis infection secondly. Diagnosis is a clinical challenge since it requires a high degree of suspicion. It usually presents as oligosymptomatic or with signs and symptoms of low cardiac output. The presence of edema, ascites and impaired liver function usually guides the study towards primary liver disease. A careful clinical history and physical examination together with adequate imaging studies are the cornerstones of the diagnosis. Surgical treatment is curative in the vast majority of patients. We present the case of a 16-year-old patient with hepatomegaly and dyspnea grade 1-2 found in a routine health check-up.
Subject(s)
Humans , Male , Adolescent , Pericarditis, Constrictive/diagnosis , Hepatomegaly/diagnosis , Pericarditis, Constrictive/surgery , Tuberculosis , Diagnostic Imaging , Diagnosis, DifferentialABSTRACT
Resumen Se expone el caso de una paciente femenina de 39 años, con antecedente de disnea progresiva y eventos recurrentes de palpitaciones, en quien durante examen físico se observó ingurgitación yugular, ascitis de gran importancia y tercer ruido cardíaco compatible con "golpe pericárdico". Las pruebas de laboratorio mostraron niveles aumentados de péptido cerebral natriurético y titulación positiva de anticuerpos para el factor antinuclear. La radiografía de tórax mostró imagen radiopaca alrededor de la silueta cardiaca en patrón de "cáscara de huevo". La reconstrucción tomográfica evidenció calcificación pericárdica circunferencial difusa, incluida la pared miocárdica del ventrículo izquierdo y el músculo anteromedial papilar de la válvula mitral.
Abstract It is presented the case of a 39 year-old female patient with a history of progressive dyspnoea and recurrent palpitation events. On physical examination jugular ingurgitation was observed, as well as a highly significant ascites, and heart sounds compatible with "pericardial knock". The laboratory test results reported increased levels of brain natriuretic peptide and a positive antibody titre for antinuclear factor. The chest X-ray showed a radio-opaque image around the cardiac outline in an "egg shell pattern". The computed tomography reconstruction showed evidence of a diffuse calcification of the pericardial circumference, including the myocardial wall of the left ventricle and the antero-medial papillary muscle of the mitral valve.
Subject(s)
Humans , Female , Adult , Pericarditis, Constrictive , Ascites , Dyspnea , Papillary Muscles , Radiography , Tomography , Heart Ventricles , Mitral ValveABSTRACT
We present the case of a 72-year-old man with constrictive pericarditis due to tuberculous pericarditis, who was treated with the waffle procedure via left anterolateral thoracotomy. The preoperative catheterization study showed the dip-and-plateau pattern, and the echocardiographic study shown the thickened pericardium and dilatation impairment. The surgery was able to be performed without cardiopulmonary bypass. The thickened pericardium was abraded with a Harmonic Scalpel. The waffle procedure was effective in this patient. The postoperative course was good, with improvement of NYHA status and cardiac pressure study results. We suggest that this procedure is useful for the patients with constrictive pericarditis.
ABSTRACT
We report a case of constrictive pericarditis with repeated hepatic encephalopathy due to hepatic cirrhosis. A 69-year-old man with exertional dyspnea and leg edema was admitted to our hospital. He had been admitted to our hospital thrice in the past 1 year owing to hepatic encephalopathy. He had hyperammonemia, hyperbilirubinemia, and renal dysfunction. Computed tomography revealed a thick pericardium with calcification and bilateral pleural effusion, and transthoracic echocardiography revealed abnormal early diastolic septal movement and right ventricular restriction. Further, cardiac catheterization identified increased central venous (36 mmHg) and a mean pulmonary arterial of 53 mmHg and a dip-and-plateau right ventricular pressure curve. We diagnosed constrictive pericarditis. Accordingly, pericardiectomy without extracorporeal circulation was performed. A hypertrophic calcified pericardium was found to be expanded throughout the right atrium to the free wall of the right ventricle. Postoperatively, the patient's exertional dyspnea and leg edema resolved, and he recovered without any complications.
ABSTRACT
A 81-year-old man underwent CABG for angina pectoris. The grafts were all patent in postoperative coronary angiography and he was discharged on postoperative day 24. Pericardial and pleural effusion appeared in 1 month after surgery. After pericardial and pleural effusion drainage, we started steroid therapy. However, his symptoms did not improve. We performed pericardiectomy under the diagnosis of constrictive pericarditis. Diastolic dysfunction improved after the surgery, and he was discharged on postoperative day 117.
ABSTRACT
Pericardial mesotheliomas are rare tumors which often present with features of constrictive pericarditis. We present clinical, imaging, histological, and immunohistochemical findings of three cases presenting with chronic constrictive pericarditis. Two of these cases were initially treated as tuberculous pericarditis. Histologically, all the three cases were of an epithelioid type and showed positivity for more than one mesothelial markers. Two patients had a fatal outcome, and one was lost to follow-up.
ABSTRACT
A 68-year-old man was referred to our hospital for mitral valve stenosis, tricuspid valve insufficiency and atrial fibrillation. We performed mitral valve replacement, tricuspid valve plasty, and the MAZE operation through a right small thoracotomy under endoscopic assistance. He was discharged uneventfully 7 days after the operation. However, about 2 months later, he developed pericardial effusion, right pleural effusion, and leg edema implying as having right heart failure. Although he was treated with diuretics and steroids, improvement was temporary and he was hospitalized repeatedly. Cardiac catheterization demonstrated dip and plateau pattern of the right ventricular pressure curve. We diagnosed that he has constrictive pericarditis, although the finding of the chest CT was non-specific without remarkable thickening or calcification of the pericardium. We performed pericardiectomy through median sternotomy without pump assist. Leather-like thickening of the pericardium was recognized in the right, anterior, and inferior portion. Resection of the thickened pericardium led to instantaneous improvement of right ventricular motion and drop of central venous pressure. The patient is in NYHA Class I, one year after pericardiectomy. Constrictive pericarditis could occur even after minimally invasive surgery, and that possibility should be kept in mind if intractable right heart failure persists.