Angiocardiographic aspects of constrictive pericarditis.

Abstract

Constrictive pericarditis can ordinarily be recognized on the basis of history, physical findings, and simple laboratory observations (1). Necessary supporting evidence is generally provided by simple roentgen examination (2). The primary physiologic abnormality of reduced stroke volume due to limited diastolic filling can be shown by right heart catheterization (3). Other diseases, chronic heart failure (4), myocardial fibrosis (3), and amyloidosis (5), occasionally present clinical and hemodynamic similarities. Characteristic electrokymographic alterations are described, although these, too, may not be specific (6). The possibility of direct demonstration of pericardial abnormality by venous angiocardiography provides another approach which has been infrequently applied. Dotter and Steinberg have called attention to the dilatation of the superior vena cava and the thickening of extraluminal soft tissues of the right heart border (7). They stated that the normal soft-tissue band does not exceed 3 mm. in width, but failed to provide the data on which this figure was based. McKusick described these and other less consistent features in 4 cases but considered that they made no contribution to the diagnosis (4). Inasmuch as helpful information has been obtained by angiocardiography in several clinically atypical cases at the University of Michigan Hospital, this review of experiences with the method is submitted. Material and Methods The angiocardiograms of 8 patients with surgically verified constrictive pericarditis, 30 individuals with no clinical evidence of pericardial disease, and 6 with pericardial effusion (3 verified by pericardial tap) were studied. The films had been made in postero-anterior projection with the subject sitting at a focus-film distance of 36 inches. Manual injection of the contrast agent (Urokon 70 per cent), serial filming at 1.3 or 2 films per second, and registration of exposure on simultaneous electrocardiogram were used. The thickness of the right heart wall was observed in each patient. It was generally clearly visualized as a soft-tissue density interposed between the lucency of the lung and the contrast material in the right atrium. Its width was measured at several points (Fig. 1). The point at which the identity of the lateral border of the superior vena cava was lost within the right atrium was labeled A. A point just above the cardiophrenic angle was labeled C, and point B was assigned to the narrowest area between A and C. Measurements were made on at least three films of each patient, frequently on more. For estimation of the speed of the intrathoracic circulation, the time in seconds between the appearance of the contrast medium in the superior vena cava and the ascending aorta was noted. The normal range, as determined by this method, has been described by one of us (8).