The changing spectrum of pericardiectomy for chronic pericarditis: Occult constrictive pericarditis

Abstract

During the past 24 years 71 patients have had a total pericardiectomy at our institution. Fifty-nine patients had the classic findings of constrictive pericarditis as the reason for operation, and the operative mortality rate was 5 percent in this group. During the past few years a new indication for total pericardiectomy has been found in 12 patients. These patients have fatigue, dyspnea, and chronic chest pain without any of the other classic findings of chronic constriction. Coronary angiograms have been normal. Cardiac catheterization following administration of a fluid load of 1,000 c.c. of warm normal saline during 6 to 8 minutes resulted in diastolic equilibration of pressures, constrictive pulse pressure contours, and loss of the normal right atrial response to inspiration in all of these patients with occult constrictive pericarditis but in none of the six normal control subjects. Total pericardiectomy has been done with ease in this group with no morbidity or deaths. Relief of the symptoms has been dramatic. Repeat cardiac catheterization following total pericardiectomy revealed normal hemodynamics prior to and following fluid load. Tissue examination of the removed pericardium revealed gross and / or microscopic changes of inflammatory disease without calcification. Occult constrictive pericarditis appears to be a new indication for total pericardiectomy and can be defined only by the hemodynamic response to a rapid saline load.