Effusive-constrictive Pericarditis Research Articles

Effusive-constrictive pericarditis as late complication of endomyocardial biopsy

Effusive-constrictive pericarditis as late complication of endomyocardial biopsy

Resolution of pericardial constriction with Anakinra in a patient with effusive-constrictive pericarditis secondary to rheumatoid arthritis

Resolution of pericardial constriction with Anakinra in a patient with effusive-constrictive pericarditis secondary to rheumatoid arthritis

Acute myopericarditis presenting as effusive-constrictive pericarditis– a case report

Myopericarditis is primarily a pericardial inflammatory syndrome occurring when clinical diagnostic criteria for pericarditis are satisfied and concurrent mild myocardial involvement is documented by elevation of biomarkers of myocardial damage (i.e. increased troponins). Limited clinical data on the causes of myopericarditis suggest that viral infections are among the most common causes in developed countries. Cardiotropic viruses can cause pericardial and myocardial in!ammation via direct cytolytic or cytotoxic effects and/or subsequent immune-mediated mechanisms. Many cases of myopericarditis are subclinical. In other patients, cardiac symptoms and signs are over shadowed by systemic manifestations of infection or inflammation. The increased sensitivity of troponin assay and contemporary widespread use of troponins has greatly increased the reported number of cases. Management is similar to that reported for pericarditis, generally with a empiric anti-inflammatory drugs mainly aimed to control symptoms. Rest and avoidance of physical activity beyond normal sedentary activities has been recommended for 6 months is recommended as for myocarditis. At present, there is no evidence that troponin elevation confers worse prognosis (i.e. a greater risk of recurrence, death or transplantation) in patients with preserved left ventricular function. Usually complete remission is seen in 3 to 6 months. We report here a case of a 18 year young man with acute myopericarditis who presented with transient effusive-constrictive pericarditis.Bangladesh Med J. 2015 Sep; 44 (3): 165-167

Redefining Effusive-Constrictive Pericarditis with Echocardiography.

BackgroundEffusive-constrictive pericarditis (ECP) is traditionally diagnosed by using the expensive and invasive technique of direct pressure measurements in the pericardial space and the right atrium. The aim of this study was to assess the diagnostic role of echocardiography in tuberculous ECP.MethodsIntrapericardial and right atrial pressures were measured pre- and post-pericardiocentesis, and right ventricular and left ventricular pressures were measured post-pericardiocentesis in patients with tuberculous pericardial effusions. Echocardiography was performed post-pericardiocentesis. Traditional, pressure-based diagnostic criteria were compared with post-pericardiocentesis systolic discordance and echocardiographic evidence of constriction.ResultsThirty-two patients with tuberculous pericardial disease were included. Sixteen had ventricular discordance (invasively measured), 16 had ECP as measured by intrapericardial and right atrial invasive pressure measurements and 17 had ECP determined echocardiographically. The sensitivity and specificity of pressure-guided measurements (compared with discordance) for the diagnosis of ECP were both 56%. The positive and negative predictive values were both 56%. The sensitivity of echocardiography (compared with discordance) for the diagnosis of ECP was 81% and the specificity 75%, while the positive and the negative predictive values were 76% and 80%, respectively.ConclusionEchocardiography shows a better diagnostic performance than invasive, pressure-based measurements for the diagnosis of ECP when both these techniques are compared with the gold standard of invasively measured systolic discordance.

Indications, timing and techniques of radical pericardiectomy via modified left anterolateral thoracotomy (ukc's modification) and total pericardiectomy via median sternotomy (holman and willett) without cardiopulmonary bypass

Background: Patients with constrictive pericarditis can be treated by pericardiectomy by either left anterolateral thoracotomy or median sternotomy. The terms “radical,” “total,” “extensive,” “complete,” “subtotal,” “adequate,” “near-total,” and partial pericardiectomy have been used often without much clarity. We describe our experience with a radical pericardiectomy technique via modified left anterolateral thoracotomy and compare the same to total pericardiectomy via median sternotomy. Methods: In this study, 67 (54.9%) patients underwent radical pericardiectomy via modified left anterolateral thoracotomy (Group I), and 55 (45.1%) patients underwent total pericardiectomy via median sternotomy (Group II). Results: The operative mortalities were 2.9% and 7.2% for the radical and total pericardiectomy groups, respectively. The time taken for normalization to Class I/II in Groups I and II was 30 ± 11 and 36 ± 14 days, respectively (P = 0.009). Surgical techniques did not affect the outcome of atrial fibrillation (P = 0. 77). Reoperation was not required for any patient. The radical pericardiectomy was also associated with less postoperative low cardiac output state as compared to patients undergoing total pericardiectomy (P < 0.001). There was no difference in mean duration of hospitalization; however, the radical pericardiectomy group achieved the New York Heart Association I and II Status quicker than the total pericardiectomy group (P = 0. 009). Conclusions: We conclude that using several technical modifications of pericardial excision, it is possible to achieve radical pericardiectomy via modified left anterolateral thoracotomy, particularly removing the constricting pericardium over the anterolateral, diaphragmatic surfaces of left ventricle and the anterior and diaphragmatic surfaces of the right ventricle until the right atrioventricular groove without using cardiopulmonary bypass in the great majority of patients undergoing pericardiectomy for chronic constrictive pericarditis. Although the surgical approach for pericardiectomy is based on surgeon's preference, left anterolateral thoracotomy is the preferred and noncontroversial approach in the setting of purulent pericarditis and effusive constrictive pericarditis to prevent sternal infection. We recommend median sternotomy approach with or without cardiopulmonary bypass, in the setting of calcific pericardial patches, pericardial masses, reoperations, and calcific pericardial “cocoon” and for those with predominant right-sided and annular involvement.

Tuberculous Pericarditis: A Complex Puzzle to Put Together

Tuberculous Pericarditis: A Complex Puzzle to Put Together

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.

Heart failure with complete recovery in a patient with systemic lupus erythematosus.

We report the case of a 43-year-old female patient who was admitted to the Cardiology Department from the Rheumatology Clinic where she was being treated for multi-organ serositis, fatigue and mild dyspnoea on exertion. The patient had a known medical history of systemic lupus erythematosus (SLE). Following extensive evaluation with blood tests for immunological and viral culprits, cardiac ultrasound, chest and abdominal computed tomography (CT) and heart magnetic resonance imaging (MRI), the diagnosis of effusive constrictive pericarditis secondary to her SLE was made. Treatment with β-blockers, diuretics and corticosteroids was given with excellent results, and one year post discharge the patient remains asymptomatic. Systemic lupus erythematosus patients often manifest cardiac complications such as pericarditis. The practising physician should always bear in mind this possibility when treating such patients.

Treatment of refractory enterovirus effusive-constrictive pericarditis with corticosteroids

A 33-year-old man presented to the emergency department with one week of fever, malaise, sinus congestion, and cough. He had no significant medical, surgical, family, or social history, and was previously on no medications. He did report contacts at work with upper respiratory tract infection symptoms. Three days prior to admission, he was prescribed amoxicillin by his primary care provider for possible bacterial sinusitis, and also started guaifenesin and ibuprofen. However, this failed to address his symptoms, and he returned to the clinic the morning of admission.

Cardiac magnetic resonance in pericardial disease

Methods CMR was performed in 146 patients (85 males, aged 56 ±16 years) with clinical suspicion of acute pericarditis (AP, n=46), pericardial effusion without inflammation (PE, n=47), and constrictive pericarditis (CP, n=53). Final diagnosis was ascertained by a combined evaluation of different CMR sequences. Patients were followed-up for all-cause and cardiac death. Results The final diagnosis was AP in 56 patients (38%), PE in 38 (26%), and CP in 42 (29%). Pericardial disease was excluded in 7 patients (5%), with CMR evidence of abundant epicardial fat. The initial diagnosis was changed by CMR in 21% of patients. Initial suspicion was confirmed in 40/46(87%) patients with AP suspicion (alternative CP diagnosis: 2, PE: 1; no pericardial disease: 3). PE was confirmed by CMR in 35/47(75%) patients (10 with a final AP diagnosis, 2 patients with absent pericardial disease). A CP diagnosis was confirmed in 40/53(75%), while 6 presented signs of AP (resembling a “transient constrictive pericarditis”), 5 PE (as “effusiveconstrictive pericarditis”), and 2 showed no pericardial disease. At Kaplan-Meyer analysis, on a 551-day median follow-up (IQ range 330-1110), patients diagnosed with CP had a worse prognosis than AP or PE patients (P <0.001).

Kussmaul's sign in effusive constrictive pericarditis

Kussmaul's sign in effusive constrictive pericarditis

IgG4-related disease with effusive–constrictive pericarditis, tamponade, and hepatopathy: A novel triad

IgG4-related disease with effusive–constrictive pericarditis, tamponade, and hepatopathy: A novel triad

Pulmonary embolism and Takotsubo syndrome as comorbidities versus employing mere pulmonary embolism to model the Takotsubo syndrome pathophysiology

neoplasms, infections, or other inflammatory disorders. It often causes sub-acute tissue damage and can lead to organ failure [1]. IgG4-RD is a corticosteroid-responsive disorder and immunosuppressive agents have been used in corticosteroid-refractory disease, however, treatment data is limited. IgG4-RD epidemiological data is scarce, however 62 to 83% patients are men and older than 50 years of age. 40% of patients with IgG4-RD have a history of allergic diseases such as bronchial asthma, chronic sinusitis, or seasonal allergies as seen in the patient presented. The pathophysiologic mechanism of IgG4-RD remains unknown. Autoimmunity, infectious agents, and molecular mimicry are thought to be potential triggers for disease development. Type-2 helper T cell immune-mediated responses are pathogenic [2]. In the case presented, recent Mycoplasma and Coxsackie B infections as well as autoimmunity, as evidenced by anti-nuclear antibody seroconversion, may have initiated the development of IgG4-RD. IgG4-RD with effusive–constrictive pericarditis, tamponade, and hepatopathy with normal serum IgG4 concentrations is a novel presentation of IgG4-RD. Increased awareness of this disease entity could potentially mitigate morbidity and improve patient outcomes. The authors report no relationships that could be construed as a conflict of interest.

Cardiac tamponade due to low-volume effusive constrictive pericarditis in a patient with uncontrolled type II autoimmune polyglandular syndrome

Type II autoimmune polyglandular syndrome (APS), a relatively common endocrine disorder, includes primary adrenal insufficiency coupled with type 1 diabetes mellitus and/or autoimmune primary hypothyroidism. Autoimmune serositis, an associated disease, may present as symptomatic pericardial effusion. We present a case of a 54-year old male with APS who developed pericarditis leading to cardiac tamponade with a subacute loculated effusion. After urgent pericardiocentesis intrapericardial pressure dropped to 0, while central venous pressures remain elevated, consistent with acute effusive constrictive pericarditis. Contrast computerized tomography confirmed increased pericardial contrast enhancement. The patient recovered after prolonged inotropic support and glucocorticoid administration. He re-accumulated the effusion 16 days later, requiring repeat pericardiocentesis. Effusive-constrictive pericarditis, an uncommon pericardial syndrome, is characterized by simultaneous pericardial inflammation and tamponade. Prior cases of APS associated with cardiac tamponade despite low volumes of effusion have been reported, albeit without good demonstration of hemodynamic findings. We report a case of APS with recurrent pericardial effusion due to pericarditis and marked hypotension with comprehensive clinical and hemodynamic assessment. These patients may require aggressive support with pericardiocentesis, inotropes, and hormone replacement therapy. They should be followed closely for recurrent tamponade.

Surgery for Aneurysmal Right Coronary Fistula and Constrictive Pericarditis in an Adult: Case Report

Coronary artery fistula (CAF) is a direct communication between a coronary artery and the lumen of any of the cardiac chambers, i.e. the coronary sinus, the pulmonary artery, the superior vena cava or the proximal pulmonary veins. The majority of these fistulas are congenital in origin although they may occasionally be detected after cardiac surgery. Congenital CAF is a rare anomaly and aneurysmal formation in the fistula is even rarer. Majority of CAFs are isolated lesions, however, congenital or acquired heart diseases may co-exist. Herein, we report a case of huge congenital aneurysmal right CAF connected to the right atrium in an Iraqi man of 62 associated with tuberculous effusive-constrictive pericarditis to whom off pump pericardiectomy was performed followed by ligation of right coronary artery and vein graft implantation to its posterior descending branch under cardiopulmonary bypass. To the best of our knowledge, such association was not previously reported. CAF can be repaired surgically with minimum risk and excellent outcome. Surgery is advised whenever coronary fistula is diagnosed unless it is very small to avoid the potential complications.

Purulent pericarditis after liver abscess: a case report.

We present the case of a 49-year-old woman, with previous clinical antecedents of recent hepatic metastasis, who was admitted to the ICU due to respiratory failure and hemodynamic instability. She was found to have purulent pericarditis complicated by pericardial tamponade and pleural effusion, as well as surgical site infection, which was the origin of the disease. Cultures of the surgical wound and the pericardial effusion were positive for Enterococcus faecalis and Escherichia coli. A pericardial tap was performed and the intra-abdominal abscess was surgically drained. Pleural effusion was also evacuated. She received antibiotic treatment and recovered successfully. The only after-effect was a well-tolerated effusive-constrictive pericarditis.

“Adhesive Pericarditis:” Intraoperative Transesophageal Echocardiographic Diagnosis of Combined Impairment of Systolic and Diastolic Function Secondary to Mycobacterium Tuberculosis

Mycobacterium tuberculosis is a well known cause of pericarditis.1 The disease may manifest echocardiographically as effusion with or without tamponade, constriction, effusion-constriction, and associated cardiomyopathy.2 Constrictive pericarditis is characterized by normal or enhanced early diastole followed by abrupt termination of ventricular filling as the maximum intrapericardial capacity is reached.3 The term effusive-constrictive pericarditis refers to pericarditis and associated effusion causing tamponade upon which drainage of the compressing fluid reveals pericardial constrictive physiology.

Pericarditis constrictiva

Constrictive pericarditis is the final stage of a chronic inflammatory process that causes fibrosis and leads to a loss of elasticity. It is characterized by an impaired diastolic heart filling which leads to a predominant right heart failure with preserved systolic function. Diagnostic goal is aimed to demonstrate characteristic hemodynamics changes secondaries to impaired pericardial compliance, and to show the pericardial involvement. Classic constrictive pericarditis is a slowly progressive disease which usually requires pericardiectomy. Other clinical presentations are: effusive-constrictive pericarditis, with pericardial effusion and concomitant tamponade and constriction, often requiring pericardiectomy; or/and transitory pericarditis, in which a brief acute inflammatory phase is followed by spontaneous remission of the constriction symptoms. Etiology, prior functional class and several comorbidities significantly affect postoperative prognosis.

Surgical management of effusive constrictive pericarditis

The surgical approach for effusive constrictive pericarditis (ECP) has not been extensively studied. We present our institution's early and long-term results of pericardiectomy in our cohort of patients with ECP. Diagnosis was made primarily by echocardiography. Right heart catheterisation was performed in eight patients. Pre-operatively, 10 patients had undergone at least one previous attempt at therapeutic pericardiocentesis. Pericardiectomy was performed where appropriate (thickened or inflamed). Of our 12 patients (50% male, median age 48 years, range 17-72 years), the underlying aetiology included idiopathic in five (41.6%), tuberculosis in four (33%), and malignancy in three patients (25%). Elective surgery was performed in nine patients. Median values of both central venous pressure and pulmonary capillary wedge pressure decreased markedly postoperatively (from 16.5 to 11.0 mmHg, p = 0.02; 20.0-15.0 mmHg, p = 0.01, respectively). There was no in-hospital mortality. Follow up ranged from three months to nine years (median three years). Five (41.6%) patients died during the follow-up period, and cumulative two-year survival was 55.6 ± 1.5%. Pericardiectomy for ECP was effective, in terms of our early results, in patients unresponsive to medical therapy. Long-term survival depends on the underlying disease.

Prevalence, Hemodynamics, and Cytokine Profile of Effusive-Constrictive Pericarditis in Patients with Tuberculous Pericardial Effusion

BackgroundEffusive constrictive pericarditis (ECP) is visceral constriction in conjunction with compressive pericardial effusion. The prevalence of proven tuberculous ECP is unknown. Whilst ECP is distinguished from effusive disease on hemodynamic grounds, it is unknown whether effusive-constrictive physiology has a distinct cytokine profile. We conducted a prospective study of prevalence and cytokine profile of effusive-constrictive disease in patients with tuberculous pericardial effusion.MethodsFrom July 2006 through July 2009, the prevalence of ECP and serum and pericardial levels of inflammatory cytokines were determined in adults with tuberculous pericardial effusion. The diagnosis of ECP was made by combined pericardiocentesis and cardiac catheterization.ResultsOf 91 patients evaluated, 68 had tuberculous pericarditis. The 36/68 patients (52.9%; 95% confidence interval [CI]: 41.2-65.4) with ECP were younger (29 versus 37 years, P=0.02), had a higher pre-pericardiocentesis right atrial pressure (17.0 versus 10.0 mmHg, P<0.0001), serum concentration of interleukin-10 (IL-10) (38.5 versus 0.2 pg/ml, P<0.001) and transforming growth factor-beta (121.5 versus 29.1 pg/ml, P=0.02), pericardial concentration of IL-10 (84.7 versus 20.4 pg/ml, P=0.006) and interferon-gamma (2,568.0 versus 906.6 pg/ml, P=0.03) than effusive non-constrictive cases. In multivariable regression analysis, right atrial pressure > 15 mmHg (odds ratio [OR] = 48, 95%CI: 8.7-265; P<0.0001) and IL-10 > 200 pg/ml (OR=10, 95%CI: 1.1, 93; P=0.04) were independently associated with ECP.ConclusionEffusive-constrictive disease occurs in half of cases of tuberculous pericardial effusion, and is characterized by greater elevation in the pre-pericardiocentesis right atrial pressure and pericardial and serum IL-10 levels compared to patients with effusive non-constrictive tuberculous pericarditis.