Constrictive Pericarditis

Abstract

Some 23 years have passed since the suggestion was first made that the symptoms of constrictive pericarditis might yield to surgical treatment (Volhard and Schmieden, 1928). This interval has ripened judgment on the effects of this therapeutic procedure, and it is now opportune to pass opinion on the value of the operation and on other aspects of the condition, especially its atiology, distinctive physical signs, and the meaning of certain cardiographic and cardioscopic appearances. These are described in the light of our experience with 30 patients who have undergone surgical treatment.The series was made up of 26 males and 4 females. The youngest patient was 11 years of age and the oldest 63; there were 6 in the second decade, 7 in the third, 3 in the fourth, 6 in the fifth, 7 in the sixth, and 1 was over sixty years of age. AETIOLOGY AND PATHOLOGYWhite (1935) and Harrison and White (1942), reporting on the progress of 1500 patients with rheumatic heart disease, found among them no instance of constrictive pericarditis. In one of our patients mitral stenosis was found side by side with constrictive pericarditis (Jackson, 1950). This one example does not justify the view that constrictive pericarditis is a rheumatic condition, and we have regarded the association as fortuitous in this patient. Apart from the rarity of mitral stenosis in constrictive pericarditis-one reported case and one in our series-the relative sex incidence of 26 males and 4 females, opposes the suggestion that the pericardial condition may have a rheumatic origin in that mitral stenosis is much commoner in women. A history of rheumatic fever was obtained in two patients only. Acute pericarditis occurred in five, and in four of them it preceded the development of signs of constriction by only a matter of months; in the fifth the attack of pericarditis happened 23 years before.We bring evidence from our cases to support the view that constrictive pericarditis is the outcome of a tuberculous infection. In four there was active tuberculosis in a close relative and in a fifth, in the family where the patient lodged; in a sixth case the patient's father had a deformed spine from Pott's disease. Involvement of the pleura was common and four gave a history of pleurisy, though in none was it proved bacteriologically to be tuberculous in nature; there was a large effusion on the right side in four cases. Pleural thickening was met with on the right side in seven,'on the left in one, and on both sides in six. Evidence of tuberculosis was found in four patients who did not undergo operative treatment and for that reason are not included in this series; in one there was fibrosis of lungs and in another active pulmonary tuberculosis; tuberculous glands were confirmed at biopsy in a third, and in a fourth there was tuberculous infection of the elbow joint. In another three patients, treated surgically and therefore included in this series, there was substantial evidence that tuberculosis had caused the infection: in one dissemination of tuberculosis in t...