Constrictive pericarditis rarely occurs in early childholofd (2, 3, 6 , 7, 11, 15); to the best of our knowledge, no proven case of this disease has been described under the age of two years. Several authors have stressed the rapidity with which the constriction sometimes develops both in adults (4) and in children (3, 7).Rapidly developing pericardial constriction should be suspected when clinical evidence of impaired ventricular filling, such as neck vein distension and hepatomegaly, persists while the heart size reiturns torward normal (1). However, the diagnosis of rapidly developitng constrictive pericarditis can sometimes be extremely difficult (3,9, 11, 17), especially in early childhood.This report is of a case of constrictive pericarditis in a 9-month-old girl, which developed only a few weeks after the onset of acute perk carditis with effusion. A speclial point of interest, in this case, is that the constriction affected principally the left ventricle. The main anatomic basis for this constriction was a large pericardial cyst, whjich gave rise to a misleading clinical, hemodynamic and angiocardiographic picture, simulating mitral valve obstruction.
CASE REPORTA 9-month-old girl was referred to the Tel-Hashomer Hospital for investigation after having been in congestive heart failure for three months. She had been hospitalized the first time a t the age of one month with a clinical picture of acute gastroenteritis. The stool culture produced Coli Oj2,,. After an appropriate treatment with antibiotic and fluid replacement she was discharged in good condition. A chest roentgenogram, performed during that hospitalization, showed the heart and lungs to be within normal limits.At the age of 5 months, she was hospitalized in the Government Hospital of Hadera because of fever, shortness of breath and coughing. On admission, she appeared restless, respiration 64 per minute, heart rate 160 per minute, rectal temperature 38.2"C. The lungs were clear to percussion, but the breath sounds were diminished over the left lower lung. The heart sounds were normal and no friction rub was detected. The liver was palpated 5 cm below the costal margin. The remainder of the physical examination was normal.The results of laboratory investigations on admission were as follows: Urinalysis normal, hemoglobin 9 g/100 ml; white blood count 16,000 mm3 with 72% neutrophils, 27% lymphocytes, 1 % monocytes; serum non protein nitrogen, cephalin flocculation, thymol turbidity and transaminase were all normal; serum sodium concentration was 130 mEq/l, potassium 6.3 mEq/l, and chloride 96 mEq/l.The chest roentgenogram taken on admission ( Fig. 1) showed normally translucent lung fields and there was moderate generalized enlargement of the heart.The electrocardiogram, taken after admission, confirmed sinus tachycardia; the P waves were normal, the P-R interval was 0.09 sec and the mean manifest electrical QRS axis in the frontal plane was + 120".The T waves were flat in the right precordial leads.The electrocardiogram, taken a week after adm...