Diagnosis Of Constrictive Pericarditis Research Articles

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

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.

Systematic review of non-invasive cardiovascular imaging in the diagnosis of constrictive pericarditis

BackgroundDiagnosis of constrictive pericarditis (CP) can be challenging. It can be nearly impossible to distinguish CP from other causes of right heart failure. Although various imaging modalities help in the diagnosis, no test is definitive. Several reviews have addressed the role of various imaging techniques in the diagnosis of CP but a systematic review has not yet been published. ObjectiveOur intention was to study the ability of various non-invasive imaging modalities to diagnose CP in patients with surgically confirmed disease and to apply our findings to develop a clinically useful diagnostic algorithm. MethodsA PubMed (NLM) search was performed with MeSH term “constrictive pericarditis”. Original articles that investigated the ability of various cardiovascular imaging modalities to noninvasively diagnose surgically confirmed CP were included in our review. Investigations that included any cases without surgical confirmation were excluded. ResultsThe PubMed search yielded 3001 results with MeSH term “constrictive pericarditis” (January 8, 2016). We identified (40) studies on CP that matched our inclusion criteria. We summarized our results sorted by individual non-invasive CV imaging modalities – echocardiography, cardiac computed tomography (CT), and magnetic resonance imaging (MRI). Under each imaging modality, we grouped our discussion based on different parameters useful in CP diagnosis. ConclusionsIn conclusion, contemporary diagnosis of CP is based on clinical features and echocardiography. Cardiac MRI is recommended in patients where echocardiography is not diagnostic. Both cardiac MRI and CT can guide surgical planning but we prefer MRI as it provides both structural and functional information.

Effect of Right Heart Systolic Function on Outcomes in Patients with Constrictive Pericarditis Undergoing Pericardiectomy.

Background:To determine the influence of right ventricular function in patients with constrictive pericarditis (CP) undergoing surgery and to compare the outcomes of patients who received surgery with those managed medically.Methods:Patients with the diagnosis of CP and healthy volunteers were recruited from January 2006 to November 2011. Patients with CP chose to either receive pericardiectomy or medical management. Echocardiographic measurements were performed to evaluate heart function, and survival was recorded.Results:A total of 58 patients with CP (36 received pericardiectomy, 22 managed medically), and 43 healthy volunteers were included. CP patients who received surgery had a higher survival rate than those managed medically (P = 0.003), and higher survival was also seen in the subgroup of CP patients with severely impaired right systolic function. Albumin level, left ventricular end-diastolic dimension, and tricuspid regurgitation velocity were associated with survival in CP patients who received surgery.Conclusions:Preoperative right heart function does not affect surgical outcomes. Patients with severely impaired preoperative right systolic function obtain a greater survival advantage with surgery than with medical treatment.

A Case Report of Tubercular Constrictive Pericarditis

Diagnosis of Constrictive pericarditis is sometimes become difficult because that requires a high degree of clinical suspicion due to nonspecific sign and symptoms. But in endemic area like our country the presentation of tubercular constrictive pericarditis is common. Here we report a case of 28 year Bangladeshi male with tubercular constrictive pericarditis presenting with progressive exertional dyspnea, ankle edema, puffyness of face, dry nonproductive caugh. After physical examination and investigation, the patient was diagnosed as constrictive pericarditis. Patient was previously diagnosed as a tubercular patient and still now on antitubercular cat-1 chemotherapy. So finally diagnosis becomes tubercular constrictive pericarditis. After improvement of the symptoms with medical treatment, the definitive surgical intervention, pericardiectomy done. Then removed pericardial tissue was sent for histopathological examination and histopathological report confirmed the diagnosis of tubercular pericarditis. This case is a late presentation of extrapulmonary manifestation of pulmonary tuberculosis, which is present as a consequence or, complication of pulmonary tuberculosis. So, early diagnosis and treatment is very much important in this case to prevent late consequence like tubercular constrictive pericarditis.University Heart Journal Vol. 10, No. 1, January 2014; 42-44

Application of medical thoracoscopy in diagnosis and treatment of pleural diseases in 9 children

Objective To describe the role of medical thoracoscopy in the diagnosis and treatment of pleural diseases in children. Methods Thoracoscopy procedures had been carried out in 9 patients with recurrent pleurisy and pleural effusion who were hospitalized in Department of Pulmonary, Intervention Qilu Children's Hospital of Shandong University from no vember 2013 to June 2015.Pleural biopsy was performed under direct visual guidance to obtain tissues, and pleural adhesion and cellulose exudation had been cleaned out in 7 cases. Results Six cases of the 9 patients had been diagnosed with tuberculous pleurisy.Pleural tumor and infectious diseases had been exclused in 1 case with biateral pleural and pericardial effusion, thickened heart capsule was found in the operation, then continuous cardiac ultrasound examination confirmed the diagnosis of constrictive pericarditis after the medical thoracoscopy procedure.The clinical symptoms were controlled in 1 case of lung abscess and empyema after cleaning out the pus moss and necrotic tissue with anti-infective therapy, the pleural adhesion was reduced.One case with empyema was converted to thoracic surgery as combined with severe pleural adhesion.Medium bleeding was found in 1 case during the procedure.Minor pneumothorax and subcutaneous emphysema occurred in 1 case after operation.There were no severe complications in the other 7 patients. Conclusions As a modern intervention technique of diagnosis and treatment of respiratory system disease, thoracoscopy is a safe and effective technique for pediatric patients. Key words: Pleural disease; Medical thoracoscopy; Child

Role of tissue characterization by Cardiac Magnetic Resonance in the diagnosis of constrictive pericarditis.

Cardiac Magnetic Resonance (CMR) allows evaluation of the functional and flow changes in pericardial constriction as well as detection of acute pericardial inflammation, fusion and thickening of pericardial layers and pericardial effusion. We sought to evaluate the diagnostic role of tissue characterization by CMR in constrictive pericarditis (CP). We performed a CMR exam in 70 patients (mean age 58 ± 16) with clinical suspicion of constrictive pericarditis and constrictive pattern at echocardiography and/or catheterization. A multiparametric CMR approach was used to evaluate the initial diagnostic suspicion. A clinical follow-up was performed in all patients for a median of 551 days. The diagnosis of CP was confirmed in 53 patients while 12 patients presented signs of predominant pericardial active inflammation suggesting a diagnosis of transient constrictive pericarditis and five presented effusive-constrictive pericarditis. Patients with a final diagnosis of CP had worse prognosis than those with transient constrictive or effusive constrictive pericarditis. The presence of myocardial late gadolinium enhancement was associated to adverse events. Results of the current study confirmed the value of CMR in the differential diagnosis of pericardial disease. A multiparametric CMR approach allowed to distinguish between active inflammation, chronic pericarditis with constriction and effusion without inflammation.

Constrictive pericarditis in a contemporary Danish cohort: Aetiology and outcome

Objectives. The aetiology and outcome of constrictive pericarditis vary between geographic regions and has changed over time. We describe the diagnostic work-up and outcome in a contemporary cohort of Danish patients with constrictive pericarditis. Design. Hospital databases were searched for patients undergoing cardiac catheterisation for suspected constrictive pericarditis or for patients undergoing pericardiectomy or discharged with the diagnosis of constrictive pericarditis. Results. We identified 57 patients with constrictive pericarditis diagnosed from 1998 to 2012. Previous surgery and inflammatory disease were the most prevalent underlying conditions. Diagnosis was made primarily by echocardiography and right- and left-sided cardiac catheterisation. Echocardiography was particularly notable for dilated inferior caval vein, increased E/A ratio, and high septal tissue velocity in addition to the presence of septal bounce. Pericardiectomy was performed in 47 patients with a 30-day mortality of 8.5%. Clinical improvement was noted in 69% of cases. Several echocardiographic parameters normalised with time, including markers of diastolic function. Conclusions. Long-term outcome after pericardiectomy is acceptable with clinical improvement and partial resolution of the echocardiographic parameters in the majority of patients.

SYSTEMIC VENOUS CONGESTION FROM IDIOPATHIC CALCIFIED CONSTRICTIVE PERICARDITIS

Constrictive pericarditis is a curable cause of chronic heart failure. The diagnosis of constrictive pericarditis can be missed due to misleading gastrointestinal manifestations. Surgical pericardectomy remains the primary therapy for constrictive pericarditis. A 41-year-old man presented for

Cardiac MR imaging in constrictive pericarditis: multiparametric assessment in patients with surgically proven constriction

To assess the utility of cardiac magnetic resonance (MR) imaging in the diagnosis of constrictive pericarditis (CP). This study was approved by the institutional review board, with a waiver of informed consent. A total of 42 consecutive patients (mean age, 55 ± 16 years; 3 women, 39 men) with CP treated with pericardiectomy who had undergone cardiac MR before surgery were evaluated retrospectively. An additional 21 patients were evaluated as a control group; of these, 10 consecutive patients received cardiac MR for reasons other than suspected pericardial disease, and 11 consecutive patients had a history of pericarditis but no clinical suspicion of pericardial constriction. MR imaging parameters were analyzed independently and with a decision tree algorithm for usefulness in the prediction of CP. Catheterization data were also reviewed when available. A model combining pericardial thickness and relative interventricular septal (IVS) excursion provided the best overall performance in prediction of CP (C statistic, 0.98, 100% sensitivity, 90% specificity). Several individual parameters also showed strong predictive value in the assessment of constriction, including relative IVS excursion (sensitivity, 93%; specificity, 95%), pericardial thickness (sensitivity, 83%; specificity, 100%), qualitative assessment of pathologic coupling (sensitivity, 88%; specificity, 100%), diastolic IVS bounce (sensitivity, 90%; specificity, 85%), left ventricle area change (sensitivity, 86%; specificity, 100%), and eccentricity index (sensitivity, 86%; specificity, 90%; all P < 0.001). Strong agreement was observed between catheterization and surgical findings of constriction (97%). Cardiac MR provides robust quantitative and qualitative analysis for the diagnosis of CP.

Constrictive Pericarditis in the Presence of Remaining Remnants of a Left Ventricular Assist Device in a Heart Transplanted Patient.

Constrictive pericarditis (CP) is a severe subform of pericarditis with various causes and clinical findings. Here, we present the unique case of CP in the presence of remaining remnants of a left ventricular assist device (LVAD) in a heart transplanted patient. A 63-year-old man presented at the Heidelberg Heart Center outpatient clinic with progressive dyspnea, fatigue, and loss of physical capacity. Heart transplantation (HTX) was performed at another heart center four years ago and postoperative clinical course was unremarkable so far. Pharmacological cardiac magnetic resonance imaging (MRI) stress test was performed to exclude coronary ischemia. The test was negative but, accidentally, a foreign body located in the epicardial adipose tissue was found. The foreign body was identified as the inflow pump connection of an LVAD which was left behind after HTX. Echocardiography and cardiac catheterization confirmed the diagnosis of CP. Surgical removal was performed and the epicardial tubular structure with a diameter of 30 mm was carefully removed accompanied by pericardiectomy. No postoperative complications occurred and the patient recovered uneventfully with a rapid improvement of symptoms. On follow-up 3 and 6 months later, the patient reported about a stable clinical course with improved physical capacity and absence of dyspnea.

Transsudat gauche et péricardite constrictive

Constrictive pericarditis is associated with thickening, fibrosis or inflammation of the pericardium which can lead to signs of right ventricle dysfunction. It is usually a chronic process which can present in a variety of ways. We present two cases of constrictive pericarditis discovered during the investigation of a left-sided pleural effusion. The cases represent two sorts of constrictive pericarditis, chronic and due to pericardial effusions. Their common feature was an increase in dyspnoea and a new pleural effusion on the left side. Their difference lies in the presence of a thickened calcified pericardium in one case and the presence of a pericardial effusion in the other. In both cases, non-invasive investigation failed to diagnose any cardiac disease. The presence of constrictive pericarditis was confirmed by right heart catheterization. Treatment by subtotal pericardectomy was effective. The thoracic manifestations of constrictive pericarditis are most commonly recurring bilateral pleural effusions. The mode of presentation may be an exudative, or transudative effusion. Unilateral pleural involvement, fibrosis, chylothorax or tumour like presentations may occur. A diagnosis of constrictive pericarditis should be considered in these clinical contexts and an examination of the pericardium performed. Cardiac catheterization can help in the differential diagnosis.

Quantitative and Pattern Analyses of Continuous-Wave Doppler–Derived Pulmonary Regurgitant Flow Velocity for the Diagnosis of Constrictive Pericarditis

Many echocardiographic features of constrictive pericarditis (CP) have been reported, but each alone has a limitation either in sensitivity or in specificity. Continuous-wave Doppler-derived flow velocity of pulmonary regurgitation can reflect the diastolic right ventricular pressure pattern characteristic of CP and be useful for its detection. Fifteen patients with CP, 18 patients with restrictive cardiomyopathy, and 20 normal subjects were studied retrospectively. Using continuous-wave Doppler echocardiography, pulmonary regurgitation velocities were measured at the early diastolic peak (VMAx), mid-diastolic inflection point (VIFL), and late diastolic minimal point (VMIN). VIFL, VIFL/VMAx, VMIN, and VMIN/VMAx were significantly lower in the CP group compared with the restrictive cardiomyopathy and normal groups. Prevalence rates of patients with early mid-diastolic inflection, VIFL/VMAx < 0.5, VMIN < 50 cm/sec, and VMIN/VMAx < 0.33 were significantly greater in the CP group compared with the other groups. Sensitivity and specificity for the diagnosis of CP were 93% and 74%, respectively, forthe presence of early mid-diastolic inflection, 73% and 100% for VIFL/VMAx < 0.5, 73% and 97% for VMIN < 50 cm/sec, and 93% and 92% for VMIN/VMAx < 0.33. The quantitative and pattern analyses of continuous-wave Doppler-derived pulmonary regurgitation velocity could enhance the accuracy of echocardiographic detection of CP.

Constrictive pericarditis--a curable diastolic heart failure.

Constrictive pericarditis can result from a stiff pericardium that prevents satisfactory diastolic filling. The distinction between constrictive pericarditis and other causes of heart failure, such as restrictive cardiomyopathy, is important because pericardiectomy can cure constrictive pericarditis. Diagnosis of constrictive pericarditis is based on characteristic haemodynamic and anatomical features determined using echocardiography, cardiac catheterization, cardiac MRI, and CT. The Mayo Clinic echocardiography and cardiac catheterization haemodynamic diagnostic criteria for constrictive pericarditis are based on the unique features of ventricular interdependence and dissociation of intrathoracic and intracardiac pressures seen when the pericardium is constricted. A complete pericardiectomy can restore satisfactory diastolic filling by removing the constrictive pericardium in patients with constrictive pericarditis. However, if inflammation of the pericardium is the predominant constrictive mechanism, anti-inflammatory therapy might alleviate this transient condition without a need for surgery. Early diagnosis of constrictive pericarditis is, therefore, of paramount clinical importance. An improved understanding of how constrictive pericarditis develops after an initiating event is critical to prevent this diastolic heart failure. In this Review, we discuss the aetiology, pathophysiology, and diagnosis of constrictive pericarditis, with a specific emphasis on how to differentiate this disease from conditions with similar clinical presentations.

Echocardiographic Diagnosis of Constrictive Pericarditis

Background— Constrictive pericarditis is a potentially reversible cause of heart failure that may be difficult to differentiate from restrictive myocardial disease and severe tricuspid regurgitation. Echocardiography provides an important opportunity to evaluate for constrictive pericarditis, and definite diagnostic criteria are needed. Methods and Results— Patients with surgically confirmed constrictive pericarditis (n=130) at Mayo Clinic (2008–2010) were compared with patients (n=36) diagnosed with restrictive myocardial disease or severe tricuspid regurgitation after constrictive pericarditis was considered but ruled out. Comprehensive echocardiograms were reviewed in blinded fashion. Five principal echocardiographic variables were selected based on prior studies and potential for clinical use: (1) respiration-related ventricular septal shift, (2) variation in mitral inflow E velocity, (3) medial mitral annular e' velocity, (4) ratio of medial mitral annular e' to lateral e', and (5) hepatic vein expiratory diastolic reversal ratio. All 5 principal variables differed significantly between the groups. In patients with atrial fibrillation or flutter (n=29), all but mitral inflow velocity remained significantly different. Three variables were independently associated with constrictive pericarditis: (1) ventricular septal shift, (2) medial mitral e', and (3) hepatic vein expiratory diastolic reversal ratio. The presence of ventricular septal shift in combination with either medial e'≥9 cm/s or hepatic vein expiratory diastolic reversal ratio ≥0.79 corresponded to a desirable combination of sensitivity (87%) and specificity (91%). The specificity increased to 97% when all 3 factors were present, but the sensitivity decreased to 64%. Conclusions— Echocardiography allows differentiation of constrictive pericarditis from restrictive myocardial disease and severe tricuspid regurgitation. Respiration-related ventricular septal shift, preserved or increased medial mitral annular e' velocity, and prominent hepatic vein expiratory diastolic flow reversals are independently associated with the diagnosis of constrictive pericarditis.

Cardiac Catheterization Provide to Diagnosis of Constrictive Pericarditis

Cardiac Catheterization Provide to Diagnosis of Constrictive Pericarditis

Pericardiectomy for treatment of neoplastic constrictive pericarditis

To share our results of a case series of 8 patients who underwent pericardiectomy for constrictive pericarditis that developed secondary to a known neoplastic disease. The underlying neoplasia was lung cancer in 5 (62.5%) patients, malignant pleural mesothelioma in 2 (25%), and Hodgkin lymphoma in 1 (12.5%). A diagnosis of constrictive pericarditis was made primarily by echocardiography, and right heart catheterization was performed in 6 (75%) patients. Total pericardiectomy was defined as wide excision of the anterior pericardium. Follow-up information was obtained by telephone interview and the civil registry database. Time from initial diagnosis of the neoplastic disease ranged from 1 to 15 years. Total pericardiectomy was performed in 6 (75%) patients. Histopathological examination revealed atypical cells in evacuated fluid and pericardial material in 6 patients. Nonspecific inflammation and fibrosis were observed in the other 2 cases. Hospital death occurred in 1 (12.5%) patient. Postoperative low cardiac output syndrome occurred in 7 (87.5%) patients. Follow-up ranged from 2.92 to 26.78 months. Mean survival was 14.82 ± 4.4 months. Pericardial constriction may develop a long time after the initial presentation of certain neoplastic diseases, and the prognosis after pericardiectomy is poor.

Cardiac magnetic resonance is a marker of active inflammation in constrictive pericarditis

The diagnosis of constrictive pericarditis (CP) is problematic and there is limited data on the role of cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement (LGE) and inflammatory markers in the diagnosis and management of CP. We sought to study the correlation of CMR LGE and inflammatory markers with disease activity of CP and response to treatment. We identified 59 patients (mean age 52 ± 10 years, 64% female) with confirmed medically managed CP between 2007 and 2010 who had serial CMR and high sensitivity C-reactive protein (hs-CRP) at baseline and follow-up (26 ± 16 weeks). At baseline, LGE was absent in 9 patients (18%) (Group 1) and present in 50 (84%) (Group 2). Patients in Group 2 had worse heart failure symptoms, higher baseline hs-CRP levels, and were more likely to be treated with prednisone and colchicine (Table 1). On follow-up CMR, none of the patients in Group 1 demonstrated LGE while the patients in Group 2 showed reduction. There was a significant decrease in heart failure symptoms and hs-CRP in Group 2 ( P = 0.01). In patients with CP, CMR can be used as a measure of ongoing inflammation and its presence correlates with disease activity. It can be performed serially in CP patients to follow disease progression and resolution with medical management, thus avoiding unwanted referrals to surgery.

Chronic constrictive pericarditis.

Constrictive pericarditis (CP) is a rare clinical entity that can pose diagnostic problems. The diagnosis of CP requires a high degree of clinical suspicion. The gold standard for diagnosis is cardiac catheterization with analysis of intracavitary pressure curves, which are high and, in end diastole, equal in all chambers. We present a patient with unexplained dyspnea, recurrent right-side pleural effusion, and ascites. Analysis of the ascitic fluid revealed a high protein content and an elevated serum-ascites gradient. Echocardiography, computed tomography, and cardiac catheterization revealed the diagnosis of CP. He underwent complete pericardiectomy and to date has made a good recovery. The diagnosis of CP is often neglected by admitting physicians, who usually attribute the symptoms to another disease process. This case exemplifies the difficulty in diagnosing this condition, as well as the investigation required, and provides a discussion of the benefit and outcomes of prompt treatment.

Pericardial calcification following blunt trauma

A 50-year-male presented with persistent, progressive shortness of breath for last 1 year along with swelling of abdomen for last 1 month. Physical examination revealed increased jugular venous pressure (14 cm of water), ascites along with presence of Kussmaul sign and pericardial knock. Clinically, a diagnosis of constrictive pericarditis (CP) was made. He denied any past history of tuberculosis or any other infective etiology. Past medical history revealed history of trauma in past childhood. Chest X-ray revealed a predominant circumferential calcification along the left border of the heart [Figure 1]. Doppler echocardiography showed evidence of CP with thick calcified pericardium. End diastolic pressure of all four chambers was also found to be equal. A diagnosis of CP due to trauma was made. Pericardial calcification is usually preceded by pericarditis or trauma. The most common causes of pericardial calcification are chronic idiopathic pericarditis, post-cardiac surgery, mediastinal irradiation, and tuberculous pericarditis. [1] Both blunt

Pericardial calcification in constrictive pericarditis

BackgroundA high index of suspicion is required to make the diagnosis of constrictive pericarditis (CP) in patients presenting with cirrhosis and volume overload, as they can otherwise go misdiagnosed for years.MethodsCase report.FindingsA 51 year-old man with a history of presumed alcoholic cirrhosis presented to the emergency department with anasarca. Abdominal ultrasound with Doppler demonstrated a nodular cirrhotic liver, but no evidence of portal hypertension or ascites. The chest x-ray, however, was significant for a right-sided pleural effusion and pericardial calcification, suggestive of (CP). Transthoracic echocardiogram and ECG-gated computerized tomography scan of the chest without IV contrast confirmed the diagnosis. The patient was referred to thoracic surgery for definitive pericardiectomy.ConclusionThe diagnosis of CP is often neglected by admitting physicians, who usually attribute the symptoms to another disease process. Although a multimodality approach is necessary for the diagnosis of CP, this case highlights the utility of chest x-ray, a relatively non-invasive and inexpensive test, in expediting the diagnosis.