Early and late results of pericardiectomy for constrictive pericarditis

McCaughan, Brian C.; Schaff, Hartzell V.; Piehler, Jeffrey M.; Danielson, Gordon K.; Orszulak, Thomas A.; Puga, Francisco J.; Pluth, James R.; Connolly, Daniel C.; McGoon, Dwight C.

doi:10.1016/s0022-5223(19)38783-5

Cited by 195 publications

(98 citation statements)

References 29 publications

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“…Peripheral edema was found in 64% of one seriesx7 and 70% of another. 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: 89%

“…Many of the physical findings that are thought characteristic of constrictive pericarditis are, in fact, quite variable. Paradoxical arterial pulse is an inconsistent finding; it was found in 40% in one series,lS 16% in another,I7 14% in another,x9 but in 84% in one study.22 A pericardial knock sound was described in 5%,17 in 46% (S3), 36 in 11 of 19 cases,xx und 36%. 89 Kussmaul's sign (inspiratory swelling of the neck veins) is a rather uncommon finding, appearing in only 13% of 95 patients.I7 This sign is not specific; it also occurs with KV failure, restrictive cardiomyopathy, RV infarction, and in tricuspid s t e n o s i~.~~ The mechanism of Kussmaul's sign is uncertain.…”

Section: Physical Examinationmentioning

confidence: 94%

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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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Section: Physical Examinationmentioning

confidence: 89%

Section: Physical Examinationmentioning

confidence: 94%

Constrictive pericarditis: Its history and current status

Fowler

1995

Clinical Cardiology

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“…[9][10][11] However, correct differentiation of these two entities is extremely important, as pericardiectomy can be curative in patients with CP. [5][6][7][8] In the modern era, different patterns of atrial and ventricular mechanics aid in distinguishing CP from other conditions, such as RCM (Table 4).…”

Section: Discussionmentioning

confidence: 99%

“…The relief from pericardial restraint using pericardiectomy is the only curative treatment for patients with CP. 7,28,42 Global LA longitudinal ε was calculated, which included peak negative ε, peak positive ε and the sum of those values, total LA ε, using 2DSTE with velocity vector imaging before and after pericardiectomy.…”

Section: Effects Of Pericardiectomy On Ventricular and Atrial Mechamentioning

confidence: 99%

Two‐dimensional speckle tracking cardiac mechanics and constrictive pericarditis: systematic review

et al. 2016

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Transthoracic echocardiography has a pivotal role in the diagnosis of constrictive pericarditis (CP). In addition to the classic M-mode, two-dimensional and Doppler indices, newer methodologies designed to evaluate myocardial mechanics, such as two-dimensional speckle tracking echocardiography (2DSTE), provide additional diagnostic and clinical information in the context of CP. Research has demonstrated that cardiac mechanics can improve echocardiographic diagnostic accuracy of CP and aid in differentiating between constrictive and restrictive ventricular physiology. 2DSTE can also be used to assess the success of pericardiectomy and its impact on atrial and ventricular mechanics. In the course of this review, we describe cardiac mechanics in patients with CP and summarize the influence of pericardiectomy on atrial and ventricular mechanics assessed using 2DSTE.

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“…However, once irreversible pericardial fibrosis has developed, the only curative therapy is radical pericardial stripping. Surgical mortality after pericardiectomy has been reported to be as high as 30%, but it is usually between 5.5 and 14.5%.1s 17,21 Most patients who survive show hernodynamic and clinical improvement that can be detected immediately. Inadequate decortication may result in persistence of constrictive symptoms and repeat surgery may be necessary.''…”

Section: Discussionmentioning

confidence: 99%

Constrictive pericarditis after coronary artery bypass surgery as a cause of unexplained dyspnea: A report of five cases

Dardas

Tsikaderis

Ioannides

et al. 1998

Clinical Cardiology

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Summary: Constrictive pencarditis after coronary artery bypass grafting (CABG) is rare and can present as unexplained dyspnea. We report five consecutive cases of post-CABG constrictive pericarditis seen within a period of I7 months at our institution. All patients presented with heart failure ofunknown etiology within a period of 8-84 months after surgery. During the initial post-CABG period, two patients had developed postcardiotomy syndrome that was successfully treated with steroids. They were all assessed noninvasively and invasively. In all patients, the diagnosis of constriction was initially suspected clinically ( symptoms, high jugular venous pressure with deep "X" and "Y" descents, pericardial knock). Echocardiography showed transmitral flow typical of constriction in all patients and hepatic venous flow in two. Two patients showed rapid left ventricular relaxation. In all patient s, hemodynamic assessment showed diastolic equalization of pressures in all chambers, "W' shape waveform in right atrial pressure, and "dip and plateau" configuration in right and left ventricular pressure waveforms. Diagnosis was confirmed surgically in four patients who were subjected to pericardiectomy-pericardial stripping (three survived. one died). One patient rehsed surgery. We conclude that constrictive pericarditis, although rare, should be suspected in every case of unexplained dyspnea post CABG. It can appear early or late after surgery, and clinical examination plays an important role in its early recognition. It requires a full noninvasive and invasive assessment in case of clinical suspicion.

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Early and late results of pericardiectomy for constrictive pericarditis

Cited by 195 publications

References 29 publications

Constrictive pericarditis: Its history and current status

Constrictive pericarditis: Its history and current status

Two‐dimensional speckle tracking cardiac mechanics and constrictive pericarditis: systematic review

Constrictive pericarditis after coronary artery bypass surgery as a cause of unexplained dyspnea: A report of five cases

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