Echocardiographic Manifestations of Constrictive Pericarditis: Abnormal Septal Motion

Abstract

Constrictive pericarditis may be difficult to differentiate from various forms of cardiomyopathy. Thus far, no distinctive echocardiographic features have been described for this entity. We have studied echocardiograms from five patients prior to and following surgery for moderate to severe constrictive pericarditis as documented by physical examination, cardiac catheterization, and findings at surgery. In all five patients a consistent and distinctive echocardiographic feature was paradoxic septal motion which could be documented along the entire interventricular septum from the aortic root to the apex of the heart. This type of abnormal septal motion was similar to that observed in conditions of right ventricular volume overload. Echocardiograms performed nine days to 15 weeks postoperatively were unchanged, except in one patient in whom partial normalization of septal motion could be documented. Measurements and observations also were made of chamber size, valve motion, wall motion, and the myocardium-pericardium interface. It is concluded that paradoxic septal motion is a sensitive, although not specific, indicator of constrictive pericarditis. Finally, while these data do not explain this type of paradoxic septal motion, they do indicate that it is not specific for right ventricular volume overload conditions.