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Chao CJ, Luis SA, Arsanjani R, Oh JK. Applications of Artificial Intelligence in Constrictive Pericarditis: A Short Literature Review. Curr Cardiol Rep 2025; 27:70. [PMID: 40067491 DOI: 10.1007/s11886-025-02222-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2025] [Indexed: 05/13/2025]
Abstract
PURPOSE OF REVIEW Constrictive pericarditis (CP) is a potentially curable condition characterized by the thickening, scarring, and calcification of the pericardium. A comprehensive approach, including clinical evaluations and imaging techniques such as echocardiography, computed tomography, and magnetic resonance imaging, is essential for timely diagnosis and intervention to prevent chronic complications and enhance patient outcomes. However, the rarity of CP and the specialized expertise required present challenges in diagnosis. RECENT FINDINGS Emerging artificial intelligence applications show promise in enhancing clinical decision-making and improving outcomes. Studies utilizing cognitive machine learning and deep learning algorithms (ResNet50) achieved an AUC above 0.95 in distinguishing CP from restrictive cardiomyopathy. However, generalization and interpretability issues remain, and the development of AI applications for CP is still nascent due to challenges in obtaining large, high-quality echocardiographic datasets. Future research should evaluate the effectiveness of these models in diverse clinical scenarios, employing comprehensive echocardiography, point-of-care ultrasound, and other modalities to improve CP detection, individualized risk assessment, and treatment planning, ultimately enhancing patient prognosis.
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Affiliation(s)
| | | | | | - Jae K Oh
- Mayo Clinic Rochester, Minnesota, USA
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2
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Baritussio A, Giordani AS, Iliceto S, Marcolongo R, Caforio ALP. Transient pericardial constriction: A not so rare entity. Int J Cardiol 2023; 390:131225. [PMID: 37524124 DOI: 10.1016/j.ijcard.2023.131225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/12/2023] [Accepted: 07/28/2023] [Indexed: 08/02/2023]
Abstract
Constrictive pericarditis is a rare, potentially treatable, cause of heart failure with preserved ejection fraction that is characterized by insidious onset, challenging diagnosis and dismal prognosis, even following complete surgical pericardiectomy, particularly in advanced disease stages. In recent years it has been proposed that transient pericardial constriction may occur, with an even rarer frequency, during early phases of acute pericarditis and may resolve following specific treatment without progressing to the chronic, irreversible form. We recently observed two cases of well-documented transient pericardial constriction. In the present work we describe these two cases and provide a review on this rare condition, that, if unrecognized and left untreated, may lead to irreversible constrictive pericarditis.
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Affiliation(s)
- Anna Baritussio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital Padua, Padua, Italy
| | - Andrea Silvio Giordani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital Padua, Padua, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital Padua, Padua, Italy
| | - Renzo Marcolongo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital Padua, Padua, Italy
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Brankovic M, Lee P, Pyrsopoulos N, Klapholz M. Cardiac Syndromes in Liver Disease: A Clinical Conundrum. J Clin Transl Hepatol 2023; 11:975-986. [PMID: 37408802 PMCID: PMC10318294 DOI: 10.14218/jcth.2022.00294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/28/2022] [Accepted: 11/28/2022] [Indexed: 07/03/2023] Open
Abstract
Understanding the interaction between the heart and liver is pivotal for managing patients in whom both organs are affected. Studies have shown that cardio-hepatic interactions are bidirectional and that their identification, assessment, and treatment remain challenging. Congestive hepatopathy is a condition that develops in the setting of long-standing systemic venous congestion. If left untreated, congestive hepatopathy may lead to hepatic fibrosis. Acute cardiogenic liver injury develops as a combination of venous stasis and sudden arterial hypoperfusion due to cardiac, circulatory, or pulmonary failure. The treatment of both conditions should be directed toward optimizing the cardiac substrate. Hyperdynamic syndrome may develop in patients with advanced liver disease and lead to multiorgan failure. Cirrhotic cardiomyopathy or abnormalities in pulmonary vasculature, such as hepatopulmonary syndrome and portopulmonary hypertension may also develop. Each complication has unique treatment challenges and implications for liver transplantation. The presence of atrial fibrillation and atherosclerosis in liver disease brings another layer of complexity, particularly in terms of anticoagulation and statin use. This article provides an overview of cardiac syndromes in liver disease, focusing on current treatment options and future perspectives.
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Affiliation(s)
- Milos Brankovic
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
- Transatlantic Cardiovascular Study Group, Bloomfield, NJ, USA
| | - Paul Lee
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Nikolaos Pyrsopoulos
- Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Mark Klapholz
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
- Division of Cardiology, Heart Failure Prevention and Treatment Program, Rutgers New Jersey Medical School, Newark, NJ, USA
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Rastegar S, Akmal A, Heller DS. Annular Indentation of the Ventricles in a Stillborn: A Case Report and Literature Review. Fetal Pediatr Pathol 2022; 41:640-642. [PMID: 33305650 DOI: 10.1080/15513815.2020.1857485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BackgroundIdiopathic indentation of the cardiac ventricles in a fetus has not been previously reported. Reported cases of congenital ventricle indentation are either caused by pericardial abnormalities or myocardial defects. Case report: We describe an incidental finding of annular indentation of the lower part of both ventricles in a stillborn male. The fetus was well-developed and the cause of stillborn was pronounced cord entanglement twice around the neck. Conclusion: Circumferential indentation of ventricles is distinguished from constrictive pericarditis and other myocardial defects as histologically the three layers of endocardium, myocardium, and pericardium are intact.
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Affiliation(s)
- Shima Rastegar
- Department of Pathology, Immunology & Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Amer Akmal
- Department of Pathology, St. Joseph's University Medical Center, Paterson, NJ, USA
| | - Debra S Heller
- Department of Pathology, Immunology & Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, NJ, USA
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Constrictive pericarditis diagnosed following liver transplantation. MARMARA MEDICAL JOURNAL 2021. [DOI: 10.5472/marumj.1012634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Asadian S, Farzin M, Tabesh F, Rezaeian N, Bakhshandeh H, Hosseini L, Toloueitabar Y, Hemmati Komasi MM. The Auxiliary Role of Cardiac Magnetic Resonance Feature-Tracking Parameters in the Differentiation between Cardiac Amyloidosis and Constrictive Pericarditis. Cardiol Res Pract 2021; 2021:2045493. [PMID: 34725571 PMCID: PMC8557086 DOI: 10.1155/2021/2045493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/30/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Cardiac amyloidosis (CA) and constrictive pericarditis (CP) are described as the differential diagnoses of restrictive hemodynamic alterations of the heart. We aimed to explain cardiac magnetic resonance (CMR) imaging findings (especially feature tracking (FT)) of CA and CP cases and compare them with healthy controls. Moreover, we evaluated the role of biventricular FT parameters in differentiating CA from CP. METHODS Thirty-eight patients who underwent CMR between February 2016 and January 2018 with the ultimate diagnosis of CA (19 patients) or CP (19 patients) were enrolled. We included biopsy-proven light-chain amyloidosis patients. The data of 28 healthy controls were utilized for comparison. The patients were followed up for 8-23 months to register mortality and their surveillance. All CMR morphological and functional data, including FT parameters, were recorded and analyzed. RESULTS Of only 13/19 (68.4%) CA patients who had the follow-up data, 11/13 (84.6%) died. One of The CP patients (5.3%) expired during the follow-up. Significant between-group differences were noted concerning the biventricular ejection fraction as well as global longitudinal, circumferential, and radial strain values (Ps < 0.001). The left ventricular (LV) global longitudinal strain (GLS) ≤10% was detected in 13/19 (68.4%) of the CA and 1/19 (5.3%) of CP cases (P < 0.001). A significant difference between the mean value of the LVGLS and LV global circumferential strain (GCS) of the basal LV level compared to the mid and apical levels was observed (Ps < 0.001) in the CA patients. The differences between the mean LVGLS and the GCS measures of the mid and apical LV levels were not significant (P=1 and P=0.06, respectively). CONCLUSIONS In our study, CA and CP severely disrupted ventricular strains. Biventricular GLS was meaningfully lower in the CA subjects. Therefore, strain analysis, especially in the longitudinal direction, could be helpful to differentiate CA from CP.
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Affiliation(s)
- Sanaz Asadian
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahta Farzin
- Iran University of Medical Sciences, Tehran, Iran
| | - Faezeh Tabesh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Rezaeian
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hooman Bakhshandeh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Hosseini
- North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Yaser Toloueitabar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Use of Impella RP for Acute Right Ventricular Failure Post-Pericardiectomy. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 28S:176-179. [PMID: 33627297 DOI: 10.1016/j.carrev.2021.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 12/20/2022]
Abstract
Surgical pericardiectomy is the accepted treatment for patients with constrictive pericarditis. Right ventricular failure in patients that undergo pericardiectomy is a frequent complication due to sudden volume overload. Impella RP is used to bypass the right ventricle and tackle the transient right ventricular failure. It is implanted percutaneously and provides enough support to achieve haemodynamical stability and recover end-organ function. We report the case of a patient that developed acute right ventricular failure in the early postoperative period of a pericardiectomy. He underwent the implantation of an Impella RP in the setting of acute right ventricular failure and was successfully explanted after 6 days of support.
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Sato K, Ayache A, Kumar A, Cremer PC, Griffin B, Popovic ZB, Jellis C, Kwon DH, Bolen M, Ramchand J, Chetrit M, Furqan MM, Johnston D, Klein AL. Improvement in left ventricular mechanics following medical treatment of constrictive pericarditis. Heart 2021; 107:828-835. [PMID: 33408090 DOI: 10.1136/heartjnl-2020-317304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Patients with constrictive pericarditis (CP) with active inflammation may show resolution with anti-inflammatory therapy. We aimed to investigate the impact of anti-inflammatory medications on constrictive pathophysiology using echocardiography in patients with CP. METHODS We identified 35 patients with CP who were treated with anti-inflammatory medications (colchicine, prednisone, non-steroidal anti-inflammatory drugs) after diagnosis of CP (mean age 58±13; 80% male). Clinical resolution of CP (transient CP) was defined as improvement in New York Heart Association class during follow-up. We assessed constrictive pathophysiology using regional myocardial mechanics by the ratio of peak early diastolic tissue velocity (e') at the lateral and septal mitral annulus by tissue Doppler imaging (lateral/septal e') or the ratio of the left ventricular lateral and septal wall longitudinal strain (LSlateral/LSseptal) by two-dimensional speckle-tracking echocardiography. Longitudinal data were analysed using a mixed effects model. RESULTS During a median follow-up of 323 days, 20 patients had transient CP, whereas 15 patients had persistent CP. Transient CP had higher baseline erythrocyte sedimentation rates (ESR) (p=0.003) compared with persistent CP. There were no significant differences in LSlateral/LSseptal and lateral/septal e'. During follow-up, only transient CP showed improvement in lateral/septal e' (p<0.001) and LSlateral/LSseptal (p=0.003), and recovery of inflammatory markers was similar between the two groups. In the logistic model, higher baseline ESR and greater improvement in lateral/septal e' and LSlateral/LSseptal were associated with clinical resolution of CP using anti-inflammatory therapy. CONCLUSIONS Improvement of constrictive physiology detected by lateral/septal e' and LSlateral/LSseptal was associated with resolution of clinical symptoms after anti-inflammatory treatment. Serial monitoring of these markers could be used to identify transient CP.
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Affiliation(s)
- Kimi Sato
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ayman Ayache
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arnav Kumar
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul C Cremer
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian Griffin
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Zoran B Popovic
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christine Jellis
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Deborah H Kwon
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael Bolen
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jay Ramchand
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael Chetrit
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Muhammad M Furqan
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Douglas Johnston
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Allan L Klein
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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De Roeck F, Prihadi EA, Vermeersch P, De Greef Y. Constrictive pericarditis as late complication of cryoballoon pulmonary vein isolation. HeartRhythm Case Rep 2020; 6:34-39. [PMID: 31956500 PMCID: PMC6962741 DOI: 10.1016/j.hrcr.2019.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/27/2019] [Accepted: 10/22/2019] [Indexed: 12/23/2022] Open
Affiliation(s)
- Frederic De Roeck
- Department of Cardiology, ZiekenhuisNetwerk Antwerpen (ZNA) – Middelheim Hospital, Antwerp, Belgium
| | - Edgard A. Prihadi
- Department of Cardiology, ZiekenhuisNetwerk Antwerpen (ZNA) – Middelheim Hospital, Antwerp, Belgium
| | - Paul Vermeersch
- Department of Cardiology, ZiekenhuisNetwerk Antwerpen (ZNA) – Middelheim Hospital, Antwerp, Belgium
| | - Yves De Greef
- Department of Cardiology, ZiekenhuisNetwerk Antwerpen (ZNA) – Middelheim Hospital, Antwerp, Belgium
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Center, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
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10
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Sumimoto K, Matsumoto K, Izawa Y, Mori S, Tanaka H, Hirata KI. "An imprisoned heart" arrested by pillory of calcified ring surrounding both ventricles: An extremely rare case of constrictive pericarditis. Echocardiography 2019; 36:2265-2267. [PMID: 31758721 DOI: 10.1111/echo.14548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 12/01/2022] Open
Abstract
We report the case of a 63-year-old man who was admitted to our hospital due to progressive dyspnea and leg edema. Echocardiography and cardiac computed tomography revealed localized severe pericardial calcification surrounding the basal segments of both ventricles, which caused pericardial constriction. Right heart catheter examination confirmed typical hemodynamic findings of constrictive pericarditis and subsequently led to the definite diagnosis of constrictive pericarditis. We experienced a rare case of localized constrictive pericarditis caused by the thickened and calcified pericardial ring. Non-invasive and invasive multimodality evaluations should be encouraged for accurate diagnosis and better management of these cases.
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Affiliation(s)
- Keiko Sumimoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kensuke Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shunpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Kumar R, Raja J, Rawat S, Srivastava A, Thingnam SKS. Chronic constrictive pericarditis complicated with huge right atrial thrombus in a child with abdominal tuberculosis: a rare life-threatening condition. J Surg Case Rep 2019; 2019:rjz295. [PMID: 31723400 PMCID: PMC6831956 DOI: 10.1093/jscr/rjz295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 08/30/2019] [Accepted: 09/02/2019] [Indexed: 11/12/2022] Open
Abstract
Chronic constrictive pericarditis (CCP) is the most common pericardial pathology. CCP complicating with intracardiac thrombus is a rare entity, the detection of thrombus preoperatively is life-saving in avoiding the risk of pulmonary thromboembolism during anterior pericardiectomy. Transesophageal echocardiography has been shown to have better sensitivity in detecting atrial thrombus than transthoracic echocardiography. Surgical removal of right atrial thrombus under cardiopulmonary bypass should be considered.
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Affiliation(s)
- Rupesh Kumar
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Javid Raja
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sanjib Rawat
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ayush Srivastava
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Shyam Kumar Singh Thingnam
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Bezjak M, Kocman B, Jadrijević S, Gašparović H, Mrzljak A, Kanižaj TF, Vujanić D, Bubalo T, Mikulić D. Constrictive pericarditis as a cause of refractory ascites after liver transplantation: A case report. World J Clin Cases 2019; 7:3266-3270. [PMID: 31667177 PMCID: PMC6819289 DOI: 10.12998/wjcc.v7.i20.3266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/23/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Refractory ascites is a rare complication following orthotopic liver transplantation (OLT). The broad spectrum of differential diagnosis often leads to delay in diagnosis. Therapy depends on recognition and treatment of the underlying cause. Constrictive pericarditis is a condition characterized by clinical signs of right-sided heart failure. In the advanced stages of the disease, hepatic congestion leads to formation of ascites. In patients after OLT, cardiac etiology of ascites is easily overlooked and it requires a high degree of clinical suspicion. CASE SUMMARY We report a case of a 55-year-old man who presented with a refractory ascites three months after liver transplantation for alcoholic cirrhosis. Prior to transplantation the patient had a minimal amount of ascites. The transplant procedure and the early postoperative course were uneventful. Standard post-transplant work up failed to reveal any typical cause of refractory post-transplant ascites. The function of the graft was good. Apart from atrial fibrillation, cardiac status was normal. Eighteen months post transplantation the patient developed dyspnea and severe fatigue with peripheral edema. Ascites was still prominent. The presenting signs of right-sided heart failure were highly suggestive of cardiac etiology. Diagnostic paracentesis was suggestive of cardiac ascites, and further cardiac evaluation showed typical signs of constrictive pericarditis. Pericardiectomy was performed followed by complete resolution of ascites. On the follow-up the patient remained symptom-free with no signs of recurrent ascites and with normal function of the liver graft. CONCLUSION Refractory ascites following liver transplantation is a rare complication with many possible causes. Broad differential diagnosis needs to be considered.
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Affiliation(s)
- Miran Bezjak
- Division of Abdominal Surgery and Organ Transplantation, Department of Surgery, University Hospital Merkur, Zagreb 10000, Croatia
| | - Branislav Kocman
- Division of Abdominal Surgery and Organ Transplantation, Department of Surgery, University Hospital Merkur, Zagreb 10000, Croatia
| | - Stipislav Jadrijević
- Division of Abdominal Surgery and Organ Transplantation, Department of Surgery, University Hospital Merkur, Zagreb 10000, Croatia
| | - Hrvoje Gašparović
- Division of Cardiology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Anna Mrzljak
- Division of Gastroenterology, Department of Internal Medicine, University Hospital Merkur, Zagreb 10000, Croatia
| | - Tajana Filipec Kanižaj
- Division of Gastroenterology, Department of Internal Medicine, University Hospital Merkur, Zagreb 10000, Croatia
| | - Darko Vujanić
- Division of Cardiology, Department of Internal Medicine, University Hospital Merkur, Zagreb 10000, Croatia
| | - Tomislav Bubalo
- Division of Abdominal Surgery and Organ Transplantation, Department of Surgery, University Hospital Merkur, Zagreb 10000, Croatia
| | - Danko Mikulić
- Division of Abdominal Surgery and Organ Transplantation, Department of Surgery, University Hospital Merkur, Zagreb 10000, Croatia
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Bezjak M, Kocman B, Jadrijević S, Gašparović H, Mrzljak A, Kanižaj TF, Vujanić D, Bubalo T, Mikulić D. Constrictive pericarditis as a cause of refractory ascites after liver transplantation: A case report. World J Clin Cases 2019. [DOI: 10.12998/wjcc.v7.i20.3267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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14
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Domingos Nunes GF, Fatela N, Ramalho F. Long-evolution ascites in a patient with constrictive pericarditis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017. [PMID: 26219528 DOI: 10.17235/reed.2015.3728/2015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Constrictive pericarditis (CP) is an uncommon disease resulting from chronic pericardial inflammation, fibrosis and calcification. Once there are atypical forms of presentation, with subtle or nonexistent cardiorespiratory symptoms, diagnosis may be challenging and difficult. Recurrent ascites in patients with congestive hepatopathy due to constrictive pericarditis is common and, in most cases, reversible after pericardiectomy. Nevertheless, development of persistent liver dysfunction may be a long-term complication. The present work describes a 23 years old man with growth delay, dyspnoea and long evolution ascites, whose exhaustive etiological investigation led to diagnosis. Afterwards the patient underwent elective surgery with symptom and general condition improvement. Ascites differential diagnosis and its association with constrictive pericarditis are briefly reviewed in this article.
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15
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Karakus A, Ari H, Camci S, Ari S, Tutuncu A, Melek M. Hourglass-shaped right ventricle and localized constrictive pericarditis. Echocardiography 2017; 34:320-321. [PMID: 28213948 DOI: 10.1111/echo.13424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Constrictive pericarditis is characterized by thick pericardial fibrosis and frequent calcification that progressively impairs diastolic filling of the heart. The diagnosis of constrictive pericarditis has been challenging even though multiple diagnostic modalities have been developed. The diagnosis of constructive pericarditis is especially difficult in localized constrictive pericarditis which is extremely rare. We report a case of localized constrictive pericarditis with a 3D multislice cardiac computed tomography (CT) finding of the constrictive band causing strangulation and hourglass shaping of the right ventricle.
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Affiliation(s)
- Alper Karakus
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
| | - Hasan Ari
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
| | - Sencer Camci
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
| | - Selma Ari
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
| | - Ahmet Tutuncu
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
| | - Mehmet Melek
- Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey
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Madeira M, Teixeira R, Costa M, Gonçalves L, Klein AL. Two-dimensional speckle tracking cardiac mechanics and constrictive pericarditis: systematic review. Echocardiography 2016; 33:1589-1599. [DOI: 10.1111/echo.13293] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Marta Madeira
- Serviço de Cardiologia; Centro Hospitalar e Universitário de Coimbra - Hospital Geral; Coimbra Portugal
| | - Rogério Teixeira
- Serviço de Cardiologia; Centro Hospitalar e Universitário de Coimbra - Hospital Geral; Coimbra Portugal
- Faculty of Medicine, University of Coimbra; Coimbra Portugal
| | - Marco Costa
- Serviço de Cardiologia; Centro Hospitalar e Universitário de Coimbra - Hospital Geral; Coimbra Portugal
| | - Lino Gonçalves
- Serviço de Cardiologia; Centro Hospitalar e Universitário de Coimbra - Hospital Geral; Coimbra Portugal
- Faculty of Medicine, University of Coimbra; Coimbra Portugal
| | - Allan L. Klein
- Heart and Vascular Institute; Center for the Diagnosis and Treatment of Pericardial Diseases; Cleveland Clinic; Cleveland OH USA
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Li L, Deng YB, Liu K, Guo LD, Liu HY, Zhou W, Tang QY. Long-Term Effects of Pericardiectomy on Left Ventricular Mechanics Evaluated by Using Speckle Tracking Echocardiography in Patients with Constrictive Pericarditis. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:421-429. [PMID: 26653938 DOI: 10.1016/j.ultrasmedbio.2015.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 09/21/2015] [Accepted: 10/29/2015] [Indexed: 06/05/2023]
Abstract
The aim of this study was to evaluate long-term changes in left ventricular (LV) mechanics after pericardiectomy in patients with constrictive pericarditis (CP) and to correlate post-operative LV mechanics with clinical status. A total of 24 patients with CP underwent serial speckle tracking echocardiography 1 wk before and 1, 6 and 12 mo after pericardiectomy. Global LV longitudinal, circumferential and radial strains, along with LV twist, were measured. Twenty-three healthy volunteers were served as control patients. Although global LV longitudinal, circumferential and radial strains obtained 6 mo after pericardiectomy increased compared with those for pre-pericardiectomy, they were still significantly lower than those for control patients. Further improvements occurred over time with normalization of global LV longitudinal and radial strains 12 mo after pericardiectomy, but global circumferential strain obtained 12 mo after pericardiectomy was still lower than that for control patients. LV twist remained unchanged after pericardiectomy. In addition, the improvements in global LV circumferential strain after pericardiectomy were associated with improvements in clinical symptoms (p < 0.001). These findings suggest that the global LV circumferential strain may be a promising parameter in the evaluation of the effectiveness of pericardiectomy.
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Affiliation(s)
- Li Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - You-Bin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Kun Liu
- Department of Medical Ultrasound, Minda Hospital of Hubei University For Nationalities, Enshi, China
| | - Ling-Dan Guo
- Department of Medical Ultrasound, Wuhan Center Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong-Yun Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Zhou
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiao-Ying Tang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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18
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Pericardiectomy for Constrictive Pericarditis: 20 Years of Experience at the Montreal Heart Institute. Ann Thorac Surg 2015; 100:107-13. [DOI: 10.1016/j.athoracsur.2015.02.054] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/23/2015] [Accepted: 02/18/2015] [Indexed: 11/17/2022]
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Abstract
We report a 43-year-old man who presented for evaluation of ascites, varices, and hepatosplenomegaly. Initial labs were notable for normal platelets, mild liver synthetic dysfunction, and disproportionately elevated alkaline phosphatase. He was presumed to have underlying cirrhosis, and diuresis was attempted without success. A transjugular liver biopsy showed marked sinusoidal dilation without cirrhosis. Diagnostic paracentesis revealed fluid studies suggestive of cardiac ascites. Further cardiac evaluation confirmed constrictive pericarditis. The case highlights the importance of considering a broad differential in the evaluation of ascites.
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20
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Marta L, Alves M, Peres M, Ferreira R, Ferreira H, Leal M, Nobre Â. Effusive-constrictive pericarditis as the manifestation of an unexpected diagnosis. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2014.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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21
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Marta L, Alves M, Peres M, Ferreira R, Ferreira H, Leal M, Nobre Â. Effusive-constrictive pericarditis as the manifestation of an unexpected diagnosis. Rev Port Cardiol 2014; 34:69.e1-6. [PMID: 25528974 DOI: 10.1016/j.repc.2014.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 08/17/2014] [Indexed: 10/24/2022] Open
Abstract
Constrictive pericarditis is a clinical condition characterized by the appearance of signs and symptoms of right heart failure due to loss of pericardial compliance. Cardiac surgery is now one of the most frequent causes in developed countries, while tuberculosis remains the most prevalent cause in developing countries. Malignancy is a rare cause but usually has a poor prognosis. The diagnosis of constrictive pericarditis remains a clinical challenge and requires a combination of noninvasive diagnostic methods (echocardiography, cardiac magnetic resonance and computed tomography); in some cases, cardiac catheterization is needed to confirm the diagnosis. The authors present the case of a 51-year-old man, hospitalized due to cardiac tamponade. Diagnostic investigation was suggestive of tuberculous etiology. Despite directed medical therapy, the patient developed effusive-constrictive physiology. He underwent pericardiectomy and anatomopathologic study suggested a neoplastic etiology. The patient died in the postoperative period from biventricular failure.
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Affiliation(s)
- Liliana Marta
- Serviço de Cardiologia, Hospital de Santarém, Santarém, Portugal.
| | - Miguel Alves
- Serviço de Cardiologia, Hospital de Santarém, Santarém, Portugal
| | - Marisa Peres
- Serviço de Cardiologia, Hospital de Santarém, Santarém, Portugal
| | - Ricardo Ferreira
- Serviço de Cirurgia Cardiotorácica, Hospital de Santa Maria - CHLN, Lisboa, Portugal
| | - Hugo Ferreira
- Serviço de Cirurgia Cardiotorácica, Hospital de Santa Maria - CHLN, Lisboa, Portugal
| | - Margarida Leal
- Serviço de Cardiologia, Hospital de Santarém, Santarém, Portugal
| | - Ângelo Nobre
- Serviço de Cirurgia Cardiotorácica, Hospital de Santa Maria - CHLN, Lisboa, Portugal
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Santoro F, Ieva R, Russo AR, Lupo P, De Bellis R, Sollitto F, Di Biase M, Brunetti ND. Late constrictive pericarditis after surgical thymectomy: multimodal imaging. J Cardiovasc Med (Hagerstown) 2014; 18:824-825. [PMID: 25379717 DOI: 10.2459/jcm.0b013e328364c08e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Francesco Santoro
- aCardiology Department bRadiology Department cThoracic Surgery Department, University of Foggia, Italy
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Lee MS, Choi JH, Kim YU, Kim SW. Ring-shaped calcific constrictive pericarditis strangling the heart: a case report. Int J Emerg Med 2014; 7:40. [PMID: 25635200 PMCID: PMC4306079 DOI: 10.1186/s12245-014-0040-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 09/19/2014] [Indexed: 11/10/2022] Open
Abstract
Constrictive pericarditis is caused by fibrosis and calcification of the pericardium, processes that inhibit diastolic filling of the heart. For the diagnosis of constrictive pericarditis, a combined approach is used to evaluate the morphologic pericardial abnormalities in conjunction with assessment of the functional and hemodynamic changes. We report novel findings of chest computed tomography (CT) and chest roentgenogram with respect to a ring-shaped pericardial calcification on atrioventricular groove causing strangulation of the heart in the patient with constrictive pericarditis, which is anatomically rarer than other severe cases of constrictive pericarditis encasing the entire heart.
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Affiliation(s)
- Mu Sook Lee
- Department of Diagnostic Radiology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, 690-767, South Korea
| | - Joon Hyouk Choi
- Department of Cardiology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, 690-767, South Korea
| | - Young Uck Kim
- Department of Cardiology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, 690-767, South Korea
| | - Su Wan Kim
- Department of Thoracic and Cardiovascular Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, 690-767, South Korea
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24
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Abstract
There is a mutual interaction between the function of the heart and the liver and a broad spectrum of acute and chronic entities that affect both the heart and the liver. These can be classified into heart diseases affecting the liver, liver diseases affecting the heart, and conditions affecting the heart and the liver at the same time. In chronic and acute cardiac hepatopathy, owing to cardiac failure, a combination of reduced arterial perfusion and passive congestion leads to cardiac cirrhosis and cardiogenic hypoxic hepatitis. These conditions may impair the liver function and treatment should be directed towards the primary heart disease and seek to secure perfusion of vital organs. In patients with advanced cirrhosis, physical and/or pharmacological stress may reveal a reduced cardiac performance with systolic and diastolic dysfunction and electrophysical abnormalities termed cirrhotic cardiomyopathy. Electrophysiological abnormalities include prolonged QT interval, chronotropic incompetance, and electromechanical uncoupling. No specific therapy can be recommended, but it should be supportive and directed against the heart failure. Numerous conditions affect both the heart and the liver such as infections, inflammatory and systemic diseases, and chronic alcoholism. The risk and prevalence of coronary artery disease are increasing in cirrhotic patients and since the perioperative mortality is high, a careful cardiac evaluation of such patients is required prior to orthotopic liver transplantation.
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Affiliation(s)
- Søren Møller
- Centre of Functional and Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, The Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Motoki H, Alraies MC, Dahiya A, Saraiva RM, Hanna M, Marwick TH, Klein AL. Changes in left atrial mechanics following pericardiectomy for pericardial constriction. J Am Soc Echocardiogr 2013; 26:640-8. [PMID: 23562086 DOI: 10.1016/j.echo.2013.02.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although impaired left ventricular (LV) filling in constrictive pericarditis (CP) is attributable to external constraints by a tethered pericardium, impaired left atrial (LA) function can further impair LV filling. Previous studies focused on the impact of a tethered pericardium on LV diastolic behavior, but its impact on LA function has been largely overlooked. The objectives of this study were to evaluate LA mechanics in CP and to assess the impact of pericardiectomy on LA mechanics. METHODS A total of 52 patients with CP (mean age, 57 ± 12 years) and 19 control subjects were studied retrospectively. All patients with CP underwent echocardiography before (median, 12 days; interquartile range, 5-34 days) and after pericardiectomy (median, 20 days; interquartile range, 5-64 days). Global LA longitudinal strain (ε) was calculated, which included peak negative ε (εnegative), peak positive ε (εpositive), and the sum of those values, total LA ε (εtotal), using speckle-tracking echocardiography with Velocity Vector Imaging. The regional difference of LA ε between the septal and lateral walls was assessed before and after the procedure. RESULTS Patients with CP showed depressed global LA εnegative, LA εtotal, and LA εpositive compared with controls. LA contractile (global LA εnegative) and reservoir functions (global LA εtotal) showed significant increases after pericardiectomy. Regional analysis revealed that the improvement in LA function after surgery was more apparent in lateral segments, while the regional function of septal walls was depressed after surgery. CONCLUSIONS Patients with CP have impaired LA mechanics, presumably because of the constrictive tethering process involving the left atrium. Speckle-tracking echocardiography showed consistent results of changes in LA mechanics with conventional echocardiographic parameters early after the procedure. Regional ε analysis aided in recognition of the impact of constrictive tethering and pericardiectomy on LA function.
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Affiliation(s)
- Hirohiko Motoki
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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26
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Veress G, Ling LH, Kim KH, Dal-Bianco JP, Schaff HV, Espinosa RE, Melduni RM, Tajik JA, Sundt TM, Oh JK. Mitral and tricuspid annular velocities before and after pericardiectomy in patients with constrictive pericarditis. Circ Cardiovasc Imaging 2011; 4:399-407. [PMID: 21543641 DOI: 10.1161/circimaging.110.959619] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies have demonstrated that mitral annulus early diastolic (e') velocity is increased in constrictive pericarditis (CP) and reduced in restrictive cardiomyopathy. However, those studies did not comprehensively evaluate mitral and tricuspid annular velocities before and after pericardiectomy. METHODS AND RESULTS We performed comprehensive echocardiography before and after pericardiectomy in 99 patients with CP, 52 with primary (idiopathic or postpericarditis etiology) and 47 with secondary CP (due to surgery or radiation). Overall, mean ± SD mitral medial, mitral lateral, and tricuspid lateral e' velocities were 12.2 ± 4.2, 10.0 ± 5.4, and 11.6 ± 3.5 cm/s, respectively; annular late diastolic velocities were 10.3 ± 4.3, 12.2 ± 4.9, and 11.7 ± 5.4 cm/s, respectively; and annular systolic (s') velocities were 7.8 ± 2.8, 8.2 ± 2.1, and 11.2 ± 3.8 cm/s, respectively. Medial e' was equal to or greater than mitral lateral e' in 74% of analyzable cases. With the exception of tricuspid s', there were significant differences in all s' and e'velocities between primary and secondary CP before pericardiectomy. After pericardiectomy, all annular velocities decreased significantly (P < 0.02 for all comparisons). The reduction in medial e' velocity was greater than that of mitral lateral e' velocity (P < 0.0001 and P = 0.0004, respectively), and the mitral lateral/medial e' ratio normalized (P = 0.0002). CONCLUSIONS The mitral lateral/medial e' ratio is reversed in three fourths of patients with CP. All annular velocities are lower in secondary compared to primary CP before pericardiectomy. After pericardiectomy, there is reduction of all annular velocities and normalization of the mitral lateral/medial e' ratio.
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Affiliation(s)
- Gabriella Veress
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
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Anderson EM, Jaroszewski DE, Arabia FA. Blunt trauma as a suspected cause of delayed constrictive pericarditis: a case report. J Med Case Rep 2011; 5:76. [PMID: 21345214 PMCID: PMC3058085 DOI: 10.1186/1752-1947-5-76] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2010] [Accepted: 02/23/2011] [Indexed: 11/21/2022] Open
Abstract
Introduction Constrictive pericarditis is a heterogeneous disease with many causes. Traumatic hemopericardium is an uncommon initiating cause. We report the case of a man developing constrictive pericarditis after blunt chest trauma, in order to highlight an approach to diagnosing the condition and to raise awareness of the possibility of this condition developing after blunt trauma. Case presentation A 72-year-old Caucasian man presented initially to our outpatient clinic with a one-year history of progressively worsening dyspnea, and recent onset of edema of the legs. He was later taken to the emergency department and admitted to hospital. He had previously received unsuccessful treatment from his local primary physicians for suspected respiratory disorder and cellulitis of his legs. Echocardiography showed evidence of pericardial constriction, and computed tomography revealed nodular, lobulated thickening of the pericardium and pleura bilaterally. Interventional biopsies were taken, but gave inconclusive results. Thus, as pericarditis and/or advanced malignancy were suspected, diagnostic video-assisted thoracoscopic surgery was performed to take biopsies from the abnormal lung and pericardial tissue. Examination of these supported the diagnosis of pericarditis, as acute and chronic inflammation and fibrous thickening were found, with no evidence of malignancy. Our patient underwent cardiac catheterization, which revealed three-vessel coronary artery disease. Emergency total pericardiectomy and coronary bypass were performed. Having excluded other common initiating factors, we considered that a blunt trauma that our patient had previously sustained to his chest was the potential cause of the constrictive pericarditis. Conclusion This was an interesting case of blunt chest trauma followed by progressive pericardial and pleural thickening. Subsequent development of chronic constrictive pericarditis occurred, requiring treatment by surgical pericardiectomy, as the clinical course of constrictive pericarditis is usually progressive without surgical intervention. Diagnosis of constrictive pericarditis remains challenging. Although uncommon, blunt trauma should be considered as a possible initiating cause. Delayed presentation of constrictive pericarditis should also be considered as a possible morbidity in a patient who has sustained blunt chest trauma. Our case also highlights the importance of performing echocardiography promptly in patients experiencing ongoing symptoms of congestive heart failure to allow earlier diagnosis of constrictive pericarditis or other cardiac disorders, and avoid unnecessary treatments.
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Affiliation(s)
- Eric M Anderson
- Department of Cardiothoracic Surgery; Mayo Clinic Arizona; 5777 East Mayo Boulevard; Phoenix, Arizona 85054, USA.
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Brendt P, Herbstreit F, Peters J. Cardiogenic shock following cesarean delivery due to undiagnosed tuberculous constrictive pericarditis. Int J Obstet Anesth 2010; 19:448-51. [PMID: 20708920 DOI: 10.1016/j.ijoa.2010.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 07/15/2009] [Accepted: 06/02/2010] [Indexed: 10/19/2022]
Abstract
We describe an uncommon cause of cardiogenic shock following cesarean delivery in a 24-year-old multiparous woman at 26 weeks of gestation. Hemodynamic instability was erroneously attributed to amniotic infection syndrome and sepsis, which resulted in delayed diagnosis and treatment of tuberculous constrictive pericarditis. Inotropic support, pericardectomy, and implantation of a left ventricular assist device were required for maternal survival.
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Affiliation(s)
- P Brendt
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Germany.
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Samara A, Bergman M, Vitrai J, Brener ZZ, Salman H. Recovery of transient pericardial constriction following steroid administration. Heart Lung Circ 2010; 19:470-2. [PMID: 20541970 DOI: 10.1016/j.hlc.2010.04.131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 03/28/2010] [Accepted: 04/16/2010] [Indexed: 11/29/2022]
Abstract
A case of transient idiopathic constrictive pericarditis is presented. Following steroid treatment there was resolution of the pericardial effusion, resolution of constriction and disappearance of the fibrin layer. The patient was followed-up for one year without any need for further treatment. Transient pericardial constriction is a rare outcome of acute pericarditis and should be promptly diagnosed before any consideration for pericardectomy.
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Affiliation(s)
- A Samara
- Department of Internal Medicine "C", Rabin Medical Center, Hasharon Hospital, 7 Keren Kayemet St, Petah-Tiqva, Israel
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Jiamsripong P, Alharthi MS, Calleja AM, McMahon EM, Mookadam F, Khandheria BK, Belohlavek M. Quantification of left ventricular twisting mechanics by velocity vector imaging in an animal model of pericardial adhesions. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:1963-1972. [PMID: 19828233 DOI: 10.1016/j.ultrasmedbio.2009.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 05/26/2009] [Accepted: 06/04/2009] [Indexed: 05/28/2023]
Abstract
Diagnosis of constrictive pericarditis remains clinically challenging. Untwisting of the left ventricle (LV) is essential for normal LV diastolic function. Echocardiography is able to measure LV twisting mechanics. We designed an animal model of constrictive pericarditis to determine how pericardial-epicardial adhesions impair LV twisting mechanics. In eight open-chest pigs, the heart was exposed while preserving the pericardium. We simulated early constrictive pericarditis by pericardial constriction and patchy adhesions induced with instant glue and pericardial-epicardial stitches. Using Velocity Vector Imaging (VVI), LV magnitudes of twisting and untwisting were measured along with hemodynamic data at baseline and after the experimental intervention. Significant decreases in end-diastolic volume, ejection fraction, stroke volume, and late diastolic filling velocity reflected the effects of the pericardial adhesions. Magnitude of LV untwisting rate decreased from -80+/-23 degrees /s to -26+/-10 degrees /s (p=0.0009). LV twisting rate dropped from 78+/-20 degrees /s to 40+/-8 degrees /s (p=0.0039) and LV twist magnitude decreased from 9+/-2 degrees to 5+/-2 degrees (p=0.0081). Patchy pericardial adhesions are associated with reductions in LV untwisting rate and twisting magnitude, consistent with a negative impact of constrictive pericarditis on systolic and diastolic function. Impairments in LV twisting mechanics may have a diagnostic role in the detection of early stages of constrictive pericarditis.
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Affiliation(s)
- Panupong Jiamsripong
- Translational Ultrasound Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, USA
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Canadian Cardiovascular Society Consensus Conference guidelines on heart failure, update 2009: diagnosis and management of right-sided heart failure, myocarditis, device therapy and recent important clinical trials. Can J Cardiol 2009; 25:85-105. [PMID: 19214293 DOI: 10.1016/s0828-282x(09)70477-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The Canadian Cardiovascular Society published a comprehensive set of recommendations on the diagnosis and management of heart failure in January 2006. Based on feedback obtained through a national program of heart failure workshops and through active solicitation of stakeholders, several topics were identified because of their importance to the practicing clinician. Topics chosen for the present update include best practices for the diagnosis and management of right-sided heart failure, myocarditis and device therapy, and a review of recent important or landmark clinical trials. These recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. The present update has been written from a clinical perspective to provide a user-friendly and practical approach. Specific clinical questions that are addressed include: What is right-sided heart failure and how should one approach the diagnostic work-up? What other clinical entities may masquerade as this nebulous condition and how can we tell them apart? When should we be concerned about the presence of myocarditis and how quickly should patients with this condition be referred to an experienced centre? Among the myriad of recently published landmark clinical trials, which ones will impact our standards of clinical care? The goals are to aid physicians and other health care providers to optimally treat heart failure patients, resulting in a measurable impact on patient health and clinical outcomes in Canada.
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