Early and late results of pericardiectomy in 118 cases of constrictive pericarditis.

Bashi, V. V.; John, Subhashini; Ravikumar, Edwin; Jairaj, P. S.; Shyamsunder, K; Krishnaswami, S

doi:10.1136/thx.43.8.637

Cited by 97 publications

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“…5,6 Instead, the number of cases of post heart surgery constrictive pericarditis has increased 2-4 and factors associated with the development of constrictive pericarditis following surgery include postoperative sternal wound infection, pericardial contamination with the irrigating agent (notably povidone iodine and iced saline slush), air-drying postoperative hemopericardium [10][11][12][13] and insertion of a pericardial substitute. 14 None of the patients in this study had postoperative hemopericardium or was flushed with iodine solution.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] In endemic areas, however, Tb remains the most common cause of constrictive pericarditis. 5,6 Thirteen years experience of constrictive pericarditis patients who underwent total pericardiectomy in a university hospital located in a rural area of Taiwan were reviewed and the clinical characteristics, especially the etiological spectrum, and operative approach were analyzed. …”

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confidence: 99%

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Clinical Characteristics and Treatment of Constrictive Pericarditis in Taiwan

Chen

Lai

2005

Circ J

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onstrictive pericarditis, an uncommon disease, is a chronic fibrous thickening of the pericardium that prevents the normal diastolic filling of the heart. Surgery is the only satisfactory treatment. Many factors associated with the development of constrictive pericarditis have been identified, such as infection, post heart surgery, post mediastinal irradiation, but in Western countries the spectrum of etiology has shifted from infection, especially Mycobacterium tuberculosis (Tb), to post heart surgery, although idiopathic causes still predominate. [1][2][3][4] In endemic areas, however, Tb remains the most common cause of constrictive pericarditis. 5,6 Thirteen years experience of constrictive pericarditis patients who underwent total pericardiectomy in a university hospital located in a rural area of Taiwan were reviewed and the clinical characteristics, especially the etiological spectrum, and operative approach were analyzed. MethodsWe retrospectively analyzed the characteristics of 23 patients (19 males, 4 females, age range 25-65 years) who underwent total pericardiectomy for constrictive pericarditis between January 1990 and December 2003. Constrictive pericarditis was diagnosed by chest roentgenography (calcified pericardium), computed tomography scan (thickened pericardium and/or pleural effusion), 7 and confirmed by cardiac catheterization (elevated end-diastolic pressure and classic "square root sign" of right ventricular pressure tracing). 8,9 The etiological factors evaluated included underlying diseases, microbiological culture results, and histopathological findings. Tubercular pericarditis was diagnosed if the histopathological section of pericardium showed the granulomatous changes of Tb. Table 1 shows the clinical characteristics of the study group prior to operation. The most common symptoms were exertional dyspnea (96%), jugular vein distension (96%), hepatomegaly (70%), general fatigue (65%), peripheral edema (65%), and ascites (52%). Pathogens isolated in 11 patients (48%) were Tb in 8 patients (35%) and streptococcus in 2 patients (9%); 1 patient had strongyloidiasis Results Clinical Characteristics and Treatment of Constrictive Pericarditis in TaiwanRobert Fu-Chean Chen, MD; Cha-Po Lai, MD* Background Constrictive pericarditis is an uncommon disease that prevents the normal diastolic filling of the heart and pericardiectomy is the only satisfactory treatment. Methods and ResultsThe clinical characteristics and treatment of patients who underwent pericardiectomy for constrictive pericarditis (n=23) were reviewed. Surgery was performed via left anterolateral thoracotomy plus transsternal extension in 3 patients, and median sternotomy in 20 patients. There were 2 deaths, resulting in an overall mortality rate of 8.7%. Of the 23 patients, 8 had Mycobacterium tuberculosis (Tb) infection, 2 had streptococcus infection, 1 had strongyloidiasis (Strongyloides stercoralis) and 1 developed the condition after a myocardial infarction; 2 patients underwent pericardial substitute insertion as post-hea...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Clinical Characteristics and Treatment of Constrictive Pericarditis in Taiwan

Chen

Lai

2005

Circ J

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“…The most common antecedents are idiopathic and tuberculosis. The tuberculosis accounted for 49% of cases of constrictive pericarditis in a series reported in 1962 [4] and it was found to be the most common cause in third-world countries such as India [5] [6]. Viral pericarditis is more common in the west and in Europe and North, it is often a sequelae of cardiac surgery and mediastinal irradiation.…”

Section: Discussionmentioning

confidence: 99%

“End-Stage” Constrictive Pericarditis—A Case Report

Muthiah¹

2017

CRCM

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Aim: To report a case of "end-stage" constrictive pericarditis with clinical manifestations such as ascites mimicking as cirrhosis of liver. Introduction: In "End-stage" constrictive pericarditis, the etiology remains unknown in majority of cases and inflammation plays a central role in its development. It has been readily confused with cirrhosis of liver in which there may be ascites, but venous pressure is normal, the neck veins are not engorged and cardiac enlargement is frequent in other causes of heart failure. Case Report: A 67 years old male presented with sudden onset of tachycardia. Clinical examination revealed right-sided heart failure, "Egg-shell" calcification in Chest X-ray and echocardiographic features of pericardial constriction such as septal bounce and dynamic respiratory changes in mitral inflow velocity. The patient was advised medical measures. Conclusion: When clinical signs of right heart failure become unresponsive to increased doses of diuretics, constrictive pericarditis is more likely the underlying disease since severe, right-sided failure develops in very advanced, the "end-stage" of the disease.

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“…'* However, in nonindustrialized nations such as India, tuberculosis was found to cause 61 % of 11 8 instances of constrictive pericarditis. 22 Constrictive pericarditis may follow n~npenetrating~~ or penetrating trauma, including cardiac surgical procedures or the penetration of pacing catheters into the pericardial space.24 Cardiac surgical procedures are estimated to be followed by constrictive pericarditis in 0.2 to 0.3% of instances; 158 cases were found in the world literature in 1989. 25 Another report in the same year described personal experience with 45 cases.…”

Section: Etiologymentioning

confidence: 99%

“…36 Schiavone reported edema in 13 of 19 cases,88 and edema was reported in 84%' of another group. 22 The cardiac apical impulse is often abscnt; this was true in 90% of Wood's series2'…”

Section: Physical Examinationmentioning

confidence: 99%

Constrictive pericarditis: Its history and current status

Fowler

1995

Clinical Cardiology

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Summary:The diagnosis of constrictive pericarditis remains a challenge because it is often mimicked by restrictive cardiomyopathy. The last few years have seen numerous advances in our ability to differentiate between these two conditions which often have similar physical findings and hemodynamics. This review begins with a brief history of constrictive pericarditis; this is followed by an extensive discussion of newer etiologies, and then the classical clinical history and physical examination findings are described. Radiologic, electrocardiographic, and angiographic findings are discussed. The hernodynamics of constrictive pericarditis are reviewed. Recent results of echocadiographic and echo-Doppler investigations are presented. Emphasis is placed upon the limitations of M-mode echocardiography in the diagnosis of constrictive pericarditis. The value of echocardiographic Doppler studies of mitral and tricuspid flow velocity patterns, as well as of those in the pulmonary veins and hepatic veins, is described. Nuclear ventriculograms and angiocardiograms tend to show more rapid ventricular filling in constrictive pericarditis than in restrictive cardiomyopathy. Although only a small number of patients has been studied, these evaluations seem to have merit in separating restrictive cardiomyopathy from constrictive pericarditis. The role of computed tomography scanning and magnetic resonance imaging studies of pericardial thickness in confirming the presence of constrictive pericarditis is discussed. Abnormal pericardial thickening (> 3 mm) confirms the diagnosis of constrictive pericarditis, but only if the characteristic hernodynamic pattern is present. The usefulness of endomyocardial biopsy in recognizing specific varieties of re- strictive cardiomyopathy is presented. The topic of occult constrictive pericardial disease is discussed briefly. A discussion of the timing of pericardial resection for the treatment of constrictive pericarditis ends the review.

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Early and late results of pericardiectomy in 118 cases of constrictive pericarditis.

Abstract: The medical records of 118 patients (86 male, 32 female, age 10-50 (mean 27) years) who underwent pericardiectomy for constrictive pericarditis at

Cited by 97 publications

References 30 publications

Clinical Characteristics and Treatment of Constrictive Pericarditis in Taiwan

Clinical Characteristics and Treatment of Constrictive Pericarditis in Taiwan

“End-Stage” Constrictive Pericarditis—A Case Report

Constrictive pericarditis: Its history and current status

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