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PubMed1972

Failure to demonstrate a humoral mechanism in the antinatriuresis of acute caval constriction.

Previous studies reported from this laboratory provided support for the hypothesis that the natriuresis of volume expansion is mediated in part by a humoral mechanism. In the present study we examined whether suppression of this factor participates in the antinatriuresis of acute constriction of the thoracic inferior vena cava. An isolated kidney was perfused by a second dog pretreated with deoxycorticosterone acetate. Expansion of the perfusion dog with equilibrated blood from a reservoir resulted in an increase in sodium excretion from 102+/-30 to 259+/-65 muEq/min, P < 0.001. Fractional sodium excretion increased from 2.3+/-0.6 to 6.2+/-1.2%, P < 0.01. Inulin clearance, plasma protein concentration, and packed cell volume remained constant; renal perfusion pressure and renal blood flow decreased. After the natriuresis was established, the thoracic inferior vena cava was constricted to decrease systemic arterial pressure in the perfusion dog 50 mm Hg. This maneuver suppressed urine output in the dog but did not significantly alter sodium excretion in the isolated kidney. During the period of caval constriction absolute sodium excretion in the isolated kidney measured 198+/-42 muEq/min and fractional sodium excretion measured 5.7+/-1.1%. Neither value is significantly different from that measured during volume expansion alone. The data suggest that the antinatriuresis of acute caval constriction probably does not require suppression of a humoral natriuretic factor and that other more rapidly acting mechanisms, presumably hemodynamic and neural, may be involved.

Animals↗
PubMedDate not supplied

Severe lower limbs lymphedema following breast carcinoma treatment revealing radiation-induced constrictive pericarditis--a case report.

In patients treated for breast carcinoma, unilateral lymphedema of the upper limb is usual. However, to the authors' knowledge, lower limb lymphedema has never been reported as a complication of breast carcinoma therapy. They report here the first case of a radiation-induced constrictive pericarditis revealed by severe lower limbs lymphedema. A 60-year-old woman was treated for left breast carcinoma with quadrantectomy, axillary lymphadenectomy, and combined radio chemotherapy (60 grays). Three and a half years later she suffered from a diffuse and increasing lower limbs lymphedema, which became huge and disabling. Radiation-induced constrictive pericarditis was evidenced by right cardiac cavities catheterization. A dramatic improvement was rapidly obtained after pericardectomy. Histopathologic analysis of the pericardium did not reveal neoplastic cells. Radiation-induced constrictive pericarditis is usually responsible for lower limbs edema, but lymphedema is exceptional. This case highlights the need to search for a constrictive pericarditis also in the case of lower limbs lymphedema, particularly in a patient treated with mediastinal radiotherapy or combined radio chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1999

Chronic constrictive pericarditis induced by long-term bromocriptine therapy: report of two cases.

OBJECTIVE: To report two cases of chronic constrictive pericarditis that appear to be related to the intake of bromocriptine for Parkinson's disease. CASE SUMMARY: Two white men (aged 63 and 69 y) were treated with bromocriptine for four (40 mg/d) and two years (30 mg/d), respectively, with a cumulative dose intake of 58.4 and 21.9 g, respectively. The patients experienced dyspnea with bilateral lower-limb edema and pleural effusion, suggesting right cardiac dysfunction. Echocardiography, computed tomography, and cardiac catheterization results were compatible with a diagnosis of constrictive pericarditis, so pericardectomy was performed on both patients. The anatomic pathology examination showed a fibrous pericardium; cultures were sterile. In the first case, pleural effusion recurred seven months after the pericarditis; bromocriptine was suspected and treatment was discontinued. In the second case, just prior to the pericardectomy, an episode of mental confusion occurred and prompted the cessation of bromocriptine therapy. DISCUSSION: To the best of our knowledge, only one case of constrictive pericarditis induced by bromocriptine therapy has previously been described in the literature. CONCLUSIONS: Our cases call attention to a possible association between bromocriptine use in patients who have Parkinson's disease and constrictive pericarditis.

Aged↗
PubMed2003

Intrauterine ductus arteriosus constriction: analysis of a historic cohort of 20 cases.

OBJECTIVE: To describe the relative incidence, presentation, and evolvement of fetuses with early ductus constriction. METHODS: Twenty fetal echocardiograms indicating ductus constriction were reviewed in a population of 7000 pregnants. RESULTS: The cases were divided into group A (related to maternal use of cyclooxygenase inhibitors [n=7] and group B (idiopathics [n=13]). Mean gestational age was 32.5 +/- 3.1 (27-38) weeks and maternal age was 28.2 +/- 8.5 (17-42) years. Mean systolic velocity in the ductus was 2.22 +/- 0.34 (1.66-2.81) m/s, diastolic velocity 0.79 +/- 0.28 (0.45-1.5) m/s, and pulsatility index 1.33 +/- 0.36 (0.52-1.83). Two cases of ductal occlusion were noted. In 65% of the cases, an increase occurred in the right cavities; in 90% of the cases, tricuspid or pulmonary regurgitation, or both, occurred, with functional pulmonary atresia in 1 case. Diastolic velocity was greater in group A (1.13 +/- 0.33) than in group B (0.68 +/- 0.15) (P=0.008). The other data were similar in the 2 groups. The evolvement was not favorable in 4 patients from group B, including 1 death and 2 cases of persistent pulmonary hypertension. CONCLUSION: The high incidence of idiopathic constriction of the ductus arteriosus suggests that its diagnosis is underestimated and that many cases of persistence of fetal circulation in newborns may be related to constriction of the ductus arteriosus not diagnosed during intrauterine life. Group B had a lower severity but a risk of an unfavorable evolvement, suggesting a distinct alteration.

Adolescent↗
PubMed1978

Angiocardiographic differentiation of constrictive pericarditis and restrictive cardiomyopathy due to amyloidosis.

The cineangiocardiograms and coronary angiograms of two cases of amyloidosis of the heart were compared to six cases of constrictive pericarditis. Three angiographic differentiating points were seen: (1) right ventricular free wall motion showed diastolic restriction in both disorders, whereas the crista supraventricularis, which moved normally in constrictive pericarditis, demonstrated restriction in amyloidosis; (2) ventricles in cases of constrictive pericarditis showed subtle further expansion during atrial systole after initial rapid filling (atrial kick), while in both cases of amyloidosis there was no motion during atrial systole; (3) pericardial thickening in constrictive pericarditis was demonstrated by failure of the distal coronary arteries to reach the surface of the cardiac image. In amyloidosis, the distal coronary arteries normally reached the periphery of the image. All three signs may be useful in differentiation, but the first is the easiest to evaluate. The right anterior oblique or posteroanterior view is the recommended projection.

Amyloidosis↗
PubMed1983

Cardiac and sinoaortic reflexes during aortic constriction in awake calves.

The hemodynamic responses to increased afterload of the left ventricle were studied in conscious calves before and during cooling of the cervical vagus nerves bilaterally. The calves were chronically instrumented to measure (or derive) heart rate, stroke volume, cardiac output, iliac, superior mesenteric and renal flows and resistances, mean aortic, right atrial, pulmonary artery, and left atrial pressures, the systemic and pulmonary pressure gradients, and total systemic and total pulmonary resistances. The calves were also instrumented to produce reversible partial constriction of the ascending aorta and for cooling of the cervical vagus nerves. The hemodynamic responses to increased afterload were characterized before and during bilateral cervical vagus nerve cooling to 6-7 degrees C. Aortic constriction causes stroke volume, cardiac output and aortic pulse pressure to decrease. Left atrial pressure and total peripheral resistance increase. Mean aortic pressure is constant during aortic constriction alone, despite a continued decrease in pulse pressure, due to a balance between sinoaortic reflexes which attempt to increase arterial pressure in response to the decreased pulse pressure and cardiopulmonary reflexes which attempt to decrease arterial pressure in response to the increased left atrial and cardiopulmonary pressures. Vagal cooling removes cardiopulmonary reflex modulation of the sinoaortic reflexes. During aortic constriction and vagal cooling, the carotid sinus reflex, acting alone, causes large increases in renal and total peripheral resistance and mean aortic pressure.

Animals↗
PubMed2005

Symptomatic pericardial constriction without active pericarditis.

The decision to undergo pericardectomy for symptomatic pericardial constriction is usually dictated by an image of an abnormal pericardium. We report a case of symptomatic pericardial constriction despite radiographic and pathological evidence of a normal pericardium. The patient was successfully treated with a pericardectomy, with resolution of constrictive hemodynamics and symptoms. Our report suggests that a normal pericardium by computed tomography and biopsy should not preclude pericardectomy for patients who have refractory symptoms, physical findings, and intracardiac pressures diagnostic of constrictive pericarditis.

Aged↗
PubMedDate not supplied

Acquired constriction ring syndrome.

Acquired constriction ring syndrome is a clinical condition of infancy characterized by circumferential constriction of a toe or another appendage, such as fingers and genitalia. The foot and ankle specialist should be aware of this condition because vascular obstruction of the affected appendage can rapidly lead to gangrene and autoamputation. Treatment consists of prompt identification and removal of the constricting foreign material. Although this condition is uncommon, it can lead to digital loss. Early treatment yields a good prognosis. A case report is presented of a 9-week-old infant who experienced acquired constriction ring syndrome caused by a strand of hair wrapped around the third and fourth toes that was treated by unwinding the hair under loupe magnification.

Constriction, Pathologic↗
PubMed1976

[Calcific constrictive pericarditis of anginal form complicated by hemopericardium and tamponade during anticoagulant treatment].

The case-history of a patient with calcified constrictive epicardopericarditis with rapidely progressive aggravation after digestive hemorrage due to excessive dose or oral anticoagulant therapy is reported. The occurrence of a cardiac tamponade has necessitated pericardectomy which has permitted to detect a partitionned hemopericardium. The surgical act was followed by gross improvement of both constrictive phenomenon and angina pectoris which have grounded the prescription of anticoagulant therapy. Anticoagulant therapy is likely responsible of the hemopericardium. Such facts are exceptionals in the course of constrictive pericarditis; diagnostic and therapeutic problems related to this complication are studied. The question of angina pectoris in the course of acute and chronic pericarditis is briefly studied by the way of this observation. Attention is drawed on the danger of the prescription of anticoagulant therapy in the course of some constrictive pericarditides.

Angina Pectoris↗
PubMed2001

Coexistence of tuberculous constrictive pericarditis and right atrial tuberculoma: a case report.

Tuberculous constrictive pericarditis is a rare condition with a high mortality rate. The coexistence of constrictive pericarditis and intracardiac tuberculoma has not previously been reported. We report the case of a 65-year-old man presenting with left-side pleural effusion and signs of systemic venous congestion for 2 months. Echocardiography and computerized tomography showed a thickened pericardium and a mass in the right atrium. Pericardiectomy and excision of the right atrial mass were performed. Pathologic examination of the pericardium and the right atrial mass both revealed chronic granulomatous inflammation with acid-fast bacilli and confirmed the diagnosis of tuberculous constrictive pericarditis and right atrial tuberculoma. This case reminds us of the possibility of this type of rare combination of tuberculous constrictive pericarditis and intracardiac right atrial tuberculoma, and the need for complete imaging studies when such cases are encountered.

Aged↗
PubMed1975

Maximal rate of fall of left ventricular pressure in cardiomyopathy and constrictive pericarditis.

The maximal rate of fall of left ventricular pressure (peak negative dp/dt) was measured in 4 patients with congestive cardiomyopathy (primary myocardial disease), in 5 patients with constrictive pericarditis and in 3 controls. Measurements were made at rest, with leg raising, after a bolus of 6 mug intravenous isoprenaline, and in patients with constrictive pericarditis during pulsus paradoxus. Peak negative dp/dt was 1810 +/- 234 mmHg/sec in controls; it was reduced in patients with constrictive pericarditis (1337 +/- 514 mmHg/sec) and greatly decreased in patients with congestive cardiomyopathy (812 +/- 190 mmHg/sec). There was close linear correlation between resting peak positive and peak negative dp/dt and there was little change with leg raising. Isoprenaline caused an increase in peak positive dp/dt, but there was only a small change in peak negative dp/dt. In patients with constrictive pericarditis, peak negative dp/dt varied during pulsus paradoxus: the linear relationship to peak positive dp/dt was maintained throughout the respiratory cycle. Peak negative dp/dt may be a useful index of myocardial function.

Adolescent↗
PubMed1975

Constriction of the femoral vein following inguinal hernia repair.

The present paper describes constriction of the femoral vein following hernioplasty ad modum McVay. In five cases, constriction of the femoral vein was demonstrated by phelbography, and pulmonary embolism by pulmonary scintigraphy. It is suggested that a number of postoperative thromboembolisms following hernia repair are caused by a unobserved constriction of the femoral vein. Moreover, constriction of the femoral vein following hernia repair occurs in a number of cases without thromboembolism.

Adult↗
PubMed2001

Acute pericarditis with transient constriction.

Transient constrictive pericarditis is a rare entity. It is characterized by clinical and echocardiographic features similar to constrictive pericarditis, but is distinguished by its transient nature. This feature is important to recognize for avoiding unnecessary pericardectomy. The case of a patient who presented with acute myopericarditis and typical echocardiographic features of constriction is described. Within weeks, all signs of constriction disappeared spontaneously.

Acute Disease↗
PubMedDate not supplied

Constrictive pericarditis presenting as massive ascites in children: report of one case.

Abdominal distension has been described as the most common presenting symptom in children with constrictive pericarditis. This report describes a 13-year-old boy who had abdominal distension with massive ascite and hepatosplenomegaly as an initial presentation. The physical signs of jugular vein engorgement and gallop rhythm as well as the pericardial calcification on the chest roentgenogram lead to the diagnosis of constrictive pericarditis. After ultrafast computed tomography and cardiac catheterization confirmation, the patient received a pericardiectomy with excellent relief of symptoms. Pathology of the pericardium reveals fibrocalcified change, but no acid fast stained bacillus nor granulomatous lesion was observed. The incidence of constrictive pericarditis with evident pericardial calcification in children is extremely low. The diagnostic value of the chest roentgenogram and physical findings for the constrictive pericarditis are addressed.

Adolescent↗
PubMed2005

Prevention of pericardial constriction by transcatheter intrapericardial fibrinolysis with urokinase.

OBJECTIVE: To investigate whether intrapericardial urokinase irrigation along with pericardiocentesis could prevent pericardial constriction in patients with infectious exudative pericarditis. METHODS: A total of 94 patients diagnosed as infectious exudative pericarditis (34 patients with purulent pericarditis and 60 with tuberculous pericarditis, the disease courses of all patients were less than 1 month), 44 males and 50 females, aged from 9 to 66 years (mean 45.4 +/- 14.7 years), were consecutively recruited from 1993 to 2002. All individuals were randomly given either intrapericardial urokinase along with conventional treatment in study group, or conventional treatment alone (including pericardiocentesis and drainage) in control group. The dosage of urokinase ranged from 200000 to 600000 U (mean 320000 +/- 70000 U). The immediate effects were detected by pericardiography with sterilized air and diatrizoate meglumine as contrast media. The long-term investigation depended on the telephonic survey and echocardiographic examination. The duration of following-up ranged from 8 to 120 months (mean 56.8 +/- 29.0 months). RESULTS: Percutaneous intrapericardial urokinase irrigation promoted complete drainage of pericardial effusion, significantly reduced the thickness of pericardium (from 3.1 +/- 1.6 mm to 1.6 +/- 1.0 mm in study group, P < 0.001; from 3.4 +/- 1.6 mm to 3.2 +/- 1.8 mm in control group, P > 0.05, respectively), and alleviated the adhesion. Intrapericardial bleeding related to fibrinolysis was found in 6 of 47 patients with non-blood pericardial effusion and no systemic bleeding and severe puncture-related complication was observed. In follow-up, there was no cardiac death, and pericardial constriction events were observed in 9 (19.1%) of study group and 27 (57.4%) of control group. Cox analysis illustrated that urokinase could significantly reduce the occurrence of pericardial constriction (relative hazard coefficient = 0.185, P < 0.0001). CONCLUSION: The early employment of intrapericardial fibrinolysis with urokinase and pericardiocentesis appears to be safe and effective in preventing the development of pericardial constriction in patients with infectious exudative pericarditis.

Adolescent↗
PubMed2005

[Diagnosis difficulty in occult constrictive pericarditis].

We report the case of a 42 years woman known to have a cardiac heart failure attributed to restrictive cardiomyopathy for want of any other plausible diagnosis. Evolution and repeted investigations finally permitted to rectify the diagnosis by revealing a constrictive pericarditis, remained occult 9 years during. The differentiation of restrictive cardiomyopathy and constrictive pericarditis has been a perennial problem in clinical cardiology. Diagnosis of constrictive pericarditis is based on associated signs sometimes too poor to go straight to thoracotomy. We discuss the mean to approach more precisely this uncommon pattern named occult constrictive pericarditis.

Adult↗
PubMed2006

[Long term evolution of chronic constrictive pericarditis. A study of 56 patients].

OBJECTIVE AND METHOD: We retrospectively analysed 56 consecutive patients with a confirmed diagnosis of chronic constrictive pericarditis over a period of 23 years. The objective was to analyse the evolution of the annual frequency of constrictive pericarditis, its aetiology and to define the prognostic factors for mortality. RESULTS: The annual frequency of constrictive pericarditis has not diminished over the 23 years of this study, remaining at 2.4 cases per year. Cases with a tuberculous origin have diminished progressively, being replaced by complications of cardiac surgery and mediastinal radiotherapy. Pericardectomy was performed in 41 patients and the average follow up was 9.5 +/- 8.6 years. By the end of the study, 34 patients had died (61.8%), 18 from a cardiovascular cause (38.3%). The independent predictive factors for overall mortality were a history of mediastinal radiotherapy, the age, and plasma sodium level. Only the presence of first degree atrio-ventricular block was an independent predictive factor for cardiovascular mortality. In the pericardectomy group, 24 patients died (60%). A history of mediastinal radiotherapy and the presence of pre-operative hyponatraemia were independent predictive factors for overall mortality. CONCLUSION: Constrictive pericarditis remains a serious pathology. Pericardectomy allows a clear functional improvement, but following pericardectomy more than 60% of patients will die within 10 years of the diagnosis being made.

Adolescent↗
PubMed1990

[Constrictive pericarditis: study by Doppler echography of blood flow in the supra-hepatic veins].

The blood flow rate in the supra-hepatic veins has been measured by Doppler ultrasound in 11 subjects suffering from more or less advanced constrictive pericarditis; the results were compared to those obtained with normal subjects. In all the pathological cases, the flow rate curve shows the following modifications: a slight decrease in the X peak, which is related to the blood "demand" caused by the decrease in the ventricular volume during the ejection, and a correlative increase in the Y peak, contemporaneous of the ventricular filling up. In the patients in which the pericarditis has not reached a marked stage of constriction, the intra-thoracic ventilatory pressure variations still exert a certain influence on the supra-hepatic blood flow rate; on the other hand, this influence is suppressed when the constriction is complete. These phenomena are parallel to the pressure modifications observed by catheterism and to those of the mitral and tricuspid transvalvular flow. The advantage of measuring the blood flow rate in the supra-hepatic veins lies in the fact that the access, for ultrasound analysis, to these vessels is quicker and more constant than to the heart valves. This method seems therefore to be an interesting one to assess the stage of development of the constricting pericarditis.

Hepatic Veins↗