Constrictive Pericarditis in 26 Patients With Histologically Normal Pericardial Thickness

Abstract

Background— Traditionally, increased pericardial thickness has been considered an essential diagnostic feature of constrictive pericarditis. Although constriction with a normal-thickness pericardium has been demonstrated clinically by noninvasive imaging, the details of clinicopathological correlates have not been described. Methods and Results— A total of 143 patients with proven constriction underwent pericardiectomy at Mayo Clinic between 1993 and 1999. Their baseline characteristics, operative data, and pathological specimens were reviewed retrospectively. The pericardium was of normal thickness (≤2 mm) in 26 patients (18%; group 1) and was thickened (>2 mm) in 117 (82%; group 2). The most common causes of constriction in group 1 included previous cardiac surgery, chest irradiation, previous infarction, and idiopathic disease. There was little difference in symptoms and findings on physical examination between the 2 groups. Microscopically, no patient had an entirely normal pericardium. Histopathological abnormalities in group 1 were mild and focal, including fibrosis, inflammation, calcification, fibrin deposition, and focal noncaseating granulomas. Pericardiectomy was equally effective in relieving symptoms regardless of the presence or absence of increased thickness. Conclusions— Pericardial thickness was not increased in 18% of patients with surgically proven constrictive pericarditis, although the histopathological appearance was focally abnormal in all cases. When clinical, echocardiographic, or invasive hemodynamic features indicate constriction in patients with heart failure, pericardiectomy should not be denied on the basis of normal thickness as demonstrated by noninvasive imaging.

Novel Model of Constrictive Pericarditis Associated With Autoimmune Heart Disease in Interferon-γ–Knockout Mice

“…Constrictive pericarditis represents a hemodynamic syndrome, which is difficult to diagnose by morphological assessment of the pericardium. Recently, Talreja et al 15 demonstrated that constrictive pericarditis does not correlate with pericardial thickness, commonly used as an index of constriction. Measurements of pressure and volume signals using in vivo LV catheterization allowed us to characterize the constrictive phenotype in IFN-␥-KO mice.…”

Hepatic venous outflow obstruction: Three similar syndromes

“…Chest X-ray may demonstrate pericardial calcification. Echocardiography is essential in the diagnosis of CP, but right and left heart catheterization with hemodynamic evaluation may be required to confirm the diagnosis [185][186][187] . Cardiac fibrosis develops more frequently and rapidly in CP than in other causes of right-sided heart failure, perhaps due to higher hepatic venous pressures leading to severe zone 3 congestion and necrosis [2] .…”

“End-Stage” Constrictive Pericarditis—A Case Report

“…Following Cardiac surgery-11% to 37% (post-pericardiectomy-10% to 40%, previous cardiac surgery-0.3%) [10] dium are fibrosed and fused together [11], although not necessarily always thickened [12], prevent the heart from expansion and resulting in minimal ability to adapt to volume changes and significant dynamic respiratory variation in blood flow in the chambers of the heart attributed to isolation of the cardiac chambers from intrathoracic respiratory pressure changes, i.e., dissociation between intrathoracic and intracardiac pressures with enhanced ventricular interaction as reported by Hatle et al in 1989 [13].…”