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PubMed1984

Neglected role of torsion and constriction in pathogenesis of simple adhesive bowel obstruction.

We critically analysed the mechanism of simple adhesive bowel obstruction in 88 re-laparotomies for this condition, paying special attention to obstructing factors beside angulation. Twenty-six obstructions were caused by bowel-to-bowel adhesion, and 42 by adhesion of bowel to other structures, whereas in the remaining 20 these two types were combined. Although angulation was almost always found at the site of obstruction, torsion (twisting of bowel about its axis) was detected in 25 of the 33 in situ observations, usually accompanied by various degrees of organic constriction. In bowel-to-bowel adhesion, the torsion and constriction were produced by a unique relation of the bowel to the adhesion; the latter connected one side of the mesenteric margin to the opposite side, encircling the bowel wall obliquely. This was never seen on nonobstructing adhesions. We conclude that torsion and constriction are important causes of simple bowel obstruction as well as strangulated obstruction.

Constriction, Pathologic↗

PubMed1999

Transient effusive-constrictive pericarditis due to chemotherapy.

Commonly used chemotherapeutic agents, specifically cytarabine and daunorubicin, can cause effusive-constrictive pericarditis. We describe a case of transient effusive-constrictive pericarditis in a patient with acute myelogenous leukemia. This is the first case report of a patient with transient effusive-constrictive pericarditis due to chemotherapy.

Antibiotics, Antineoplastic↗

PubMed2003

Idiopathic calcific constrictive pericarditis causing pulmonary stenosis associated with a ventricular septal defect mimicking tetralogy of Fallot.

We describe an unusual case of pulmonary stenosis caused by calcific constrictive pericarditis associated with a congenital ventricular septal defect in a 16-year-old boy who had a 2-week history of progressive dyspnea, cyanosis, fatigue, and bilateral leg edema. Echocardiographic findings led to an initial diagnosis of tetralogy of Fallot; however, findings on chest radiography and CT were suggestive of calcific constrictive pericarditis with pulmonary stenosis, which was then confirmed on cardiac catheterization. Total pericardiectomy and repair of the ventricular septal defect resulted in a satisfactory outcome. Follow-up examinations at 6 and 20 months showed that the patient was asymptomatic and considered to have class I New York Heart Association functional status. To our knowledge, this is the first reported case of calcific constrictive pericarditis with pulmonary stenosis associated with a ventricular septal defect.

Adolescent↗

PubMed2005

Severe ductal constriction in the third-trimester fetus following maternal self-medication with nimesulide.

OBJECTIVE: This was a multicenter series of 10 cases of constriction of the fetal ductus arteriosus occurring after maternal ingestion of one or two oral doses of nimesulide, which led to emergency delivery in four cases. METHODS: The computerized databases of three referral centers were searched for all cases of ductal constriction detected during the last 8 years in association with maternal ingestion of nimesulide. Ten cases were retrieved and represent the study population. The following variables were analyzed: gestational age at diagnosis, reason for nimesulide ingestion, total nimesulide dose, time interval between drug intake and ultrasound examination, indication for echocardiography, presence of right ventricular hypertrophy, presence of tricuspid valve regurgitation, ductal systolic and diastolic peak velocities, ductal pulsatility index, signs of fetal heart failure, pregnancy and feto-neonatal outcome, and ductal status at neonatal echocardiography. RESULTS: Nimesulide ingestion was the result of self-medication in all cases. The mean gestational age at diagnosis was 36.3 weeks and the mean time interval between nimesulide intake and echocardiographic examination was 2.9 days. The five cases with ductal peak velocities > 2.5 m/s showed right ventricular dysfunction with significant tricuspid regurgitation. At echocardiography performed immediately after birth, the ductus appeared closed in all cases and two neonates showed persistent pulmonary hypertension requiring intermittent positive pressure ventilation and nitric oxide therapy for 1 week. CONCLUSIONS: Although the true incidence of the adverse effect of nimesulide ingestion during pregnancy cannot be deduced, we believe that patients and their clinicians should be alerted to the possibility that clinically significant ductal constriction may follow maternal self-medication with just one or two oral doses of nimesulide, at least if the drug is taken near term.

Administration, Oral↗

PubMed1990

Felodipine prevents the poststenotic myocardial ischemia induced by alpha 2-adrenergic coronary constriction.

Alpha 2-adrenoceptor-mediated coronary constriction contributes to the precipitation of myocardial ischemia during sympathetic activation. Felodipine is a novel dihydropyridine calcium-channel antagonist with vascular selectivity. In this study, the effect of felodipine on alpha 2-adrenoceptor-mediated poststenotic coronary constriction was investigated. In ten open-chest dogs, the selective alpha 2-adrenoceptor agonist BHT 933 (200 micrograms IC) was infused before and after production of a severe stenosis on the left circumflex coronary artery. BHT 933 increased calculated resistance of the intact left circumflex coronary artery from 1.16 +/- 0.30 (SD) to 2.00 +/- 0.70 mmHg*min*100 g/ml (p less than 0.05) without changing posterior systolic wall thickening (sonomicrometry) (14.2 +/- 2.8% vs. 14.1 +/- 2.7%). In the presence of a severe stenosis, BHT 933 increased poststenotic coronary resistance from 1.59 +/- 0.54 to 2.88 +/- 1.16 mmHg*min*100 g/ml (p less than 0.05) and decreased posterior systolic wall thickening from 11.9 +/- 2.7% to 8.2 +/- 3.1% (p less than 0.05). In contrast, after intravenous pretreatment with felodipine (4 micrograms/kg), intracoronary infusion of BHT 933 did not change coronary resistance (1.69 +/- 0.61 vs. 1.61 +/- 0.64 mmHg*min*100 g/ml) and posterior systolic wall thickening (12.1 +/- 3.0% vs. 12.6 +/- 2.9%). In conclusion, felodipine prevents alpha 2-adrenoceptor-mediated coronary constriction and ischemic regional myocardial dysfunction distal to a severe coronary stenosis.

Adrenergic alpha-Agonists↗

PubMed1981

The calibre of cerebral arteries of the rat studied by carotid angiography: a model system for studying the aetiology of human cerebral arterial constriction after aneurysmal rupture.

Rupture of human cerebral arterial aneurysms is followed by prolonged cerebral arterial constriction; there is evidence that cerebrospinal fluid (CSF) from such patients contains vasoconstrictor substances which may cause the arterial constriction. The aim of this study was to develop a small animal model for investigating the effects of such CSF on the calibre of cerebral vessels in situ. Carotid angiography of the cerebral arteries of the rat visualizes the internal carotid, middle cerebral, anterior cerebral and stapedial arteries plus the vertebrobasilar system. Prostacyclin was injected during carotid catheterisation to prevent spontaneous and random occlusion of these cerebral arteries; in the presence of prostacyclin there was no arterial occlusion for up to 5 h. The resolution achieved by the angiographic technique, which magnified the cerebral circulations 2.9 times, was sufficient to measure the diameter of the internal carotid and stapedial arteries of the rat. Intracarotid infusion of 1.0 ml CSF collected from patients with ruptured cerebral arterial aneurysms caused a rapidly developing contraction of cerebral arteries lasting up to 5 h. Thus, we consider that the rat may also be used as a model for investigating the aetiology of human cerebral arterial constriction after aneurysmal rupture.

Animals↗

PubMed1993

Constrictive pericarditis simulating intestinal lymphangiectasia in a patient with the Noonan syndrome.

A case of constrictive pericarditis with marantic endocarditis in a patient with the Noonan syndrome is reported. Congenital heart defects are often diagnosed in the Noonan syndrome and are undoubtedly the most problematic of its pathologies. Our patient had surgery for pulmonic stenosis at age 10 and 16 years. Over a period of 1-2 years prior to death at age 23 years, he developed elevated jugular venous pressure, hypoproteinaemia, pedal oedema and pleural effusions. The hypoproteinaemia and resulting signs were initially attributed to intestinal lymphangiectasia. The latter, unlike constrictive pericarditis, has been reported in the Noonan syndrome. Post-mortem examination revealed constrictive pericarditis with a marantic endocarditis. There was no evidence of intestinal lymphangiectasia.

Adult↗

PubMed2002

Massive right pleural effusion and ascites caused by a primary constrictive pericardial band.

A previously healthy 57-year-old woman with peripheral edema and exertional dyspnea had diminished right breath sounds and edema of both legs. Chest radiography showed massive right pleural effusion, and abdominal computed tomography showed ascites. During cardiac catheterization, pressure curves of both ventricles showed "dip-and-plateau" patterns. We diagnosed constrictive pericarditis and conducted pericardiectomy. During surgery, we found a thick fibrous pericardium surrounding the entire heart and a band of calcium in the atrioventricular groove. Histological examination of excised pericardial tissue showed fibrosis, hyalinization, and calcification, with thickening of < or = 18 mm. Cases of localized pericardial thickening, including constricting bands in the atrioventricular groove, are rare and many such complications occur postoperatively. We report a rare case of primary constrictive pericardial band resulting in massive right pleural effusion and ascites.

Ascites↗

PubMed1998

[One-stage surgery for Stanford type-A aortic dissection, annulo-aortic ectasia, and chronic constrictive pericarditis--a case report].

A case is reported of a rare combination of chronic constrictive pericarditis and aortic dissection. A 23-year-old male was diagnosed with constrictive pericarditis and annulo-aortic ectasia concomitant with type-A dissection. A pericardiectomy was performed under cardiopulmonary bypass, and an aortic segment, from the root to the arch, was totally replaced by a composite graft using selective cerebral perfusion. Both procedures were performed in one stage. An aged clot was found in the pericardial cavity. Sustained rupture of the aortic dissection into the pericardial cavity is considered to be a possible explanation for the development of constrictive pericarditis. The postoperative course was uneventful and the patient was discharged 34 days after the operation.

Adult↗

PubMedDate not supplied

Severe heart failure due to subacute effusive-constrictive pericarditis in a child.

We report a 9-year-old boy with progressive heart failure due to effusive-constrictive pericarditis. The patient was successfully rescued by extensive surgical removal of the thickened pericardium. The histopathological examination revealed degenerative changes of myocardium without significant inflammation, indicating that surgical pericardiectomy should be performed for subacute effusive-constrictive pericarditis before progression to definite constrictive pericarditis.

Child↗

PubMed2004

Structural displacements affecting pharyngeal constriction in nondysphagic elderly and nonelderly adults.

This study investigated spatial displacement variables important to pharyngeal constriction and clearing in nondysphagic elderly subjects and a control group of nondysphagic younger adults. Height, weight, and body mass index (BMI) characteristics were determined for all subjects, who then underwent videofluoroscopic swallow studies. Measures obtained during swallow of a 20-cc bolus included hyoid and laryngeal displacement, unobliterated pharyngeal space at the point of maximum pharyngeal constriction, and pharyngeal width when maximally expanded during the swallow. Data were first examined to determine if elderly subjects with medical conditions common to an aged population differed from elderly subjects with no medical condition. No differences were identified and data for all elderly subjects were subsequently pooled for comparison to data for the nonelderly control group. Findings revealed no differences in maximum hyoid displacement between the groups. Significant differences were identified for larynx-to-hyoid approximation and for the measure representing unobliterated pharyngeal space at the point of maximum pharyngeal constriction. Elderly subjects did not elevate the larynx to the same extent, or clear the pharynx, as well as the younger control subjects. In addition, data suggested that the larynx was positioned lower and that the width of the pharynx maximally expanded was greater in elderly subjects. Implications of the data for swallowing function in the elderly are discussed.

Adolescent↗

PubMed2006

Protein-losing enteropathy in association with constrictive pericarditis.

Although acute pericarditis is a common and usual benign disorder, sometimes evolution to constrictive pericarditis may occur. We present a case of constrictive pericarditis late after coronary bypass grafting, complicated by right sided heart failure. Edema formation was aggravated due to protein-losing enteropathy, resulting in hypoalbuminemia. Imaging of constrictive pericarditis was done by ultrasound as well as simultaneous pressure recording of the right and left ventricle. Imaging of intestinal protein loss was possible using intravenous Technetium-99m-labelled human serum albumin.

Aged↗

PubMed1984

The septal arteries in the differential diagnosis of constrictive pericarditis.

Angiographic study of the motion of the septal and left marginal arteries was performed in patients with restriction in ventricular diastolic filling in order to separate patients with constrictive pericarditis from those with restrictive cardiomyopathy. Twelve patients with constrictive pericarditis (group I) and 10 patients with restrictive cardiomyopathy (group II) were evaluated and compared with 21 patients with normal coronary angiograms (group III). The displacement of the septal arteries (23 +/- 2.04 mm) was abnormally exaggerated in group I and normal (9 +/- 0.81 mm) in groups II and III. The displacement of the left marginal arteries as seen by the "corrugating index" was similar in all groups. We conclude that study of the displacement of the septal arteries is a useful angiographic sign that helps to separate constrictive pericarditis from restrictive cardiomyopathy and normals.

Cardiomyopathies↗

PubMed1978

Hemodynamic pattern resembling pericardial constriction after acute inferior myocardial infarction with right ventricular infarction.

Two patients with acute inferior myocardial infarction complicated by cardiogenic shock are presented. Cardiac catheterization 2 and 7 days after infarction, respectively, revealed a hemodynamic pattern resembling constrictive pericarditis. Right coronary occlusion proximal to the right ventricular marginal branches was present in both patients. Resolution of the constrictive hemodynamic pattern was demonstrated in the one survivor at repeat catheterization 7 weeks after infarction. The mechanism for constrictive hemodynamics in these patients is unclear.

Acute Disease↗

PubMed1979

Constrictive pericarditis: early and late complication of cardiac surgery.

Constrictive pericarditis is not considered a complication of cardiac surgery. However, three cases are presented in which equalization of diastolic pressures and the ventricular pressure pattern of early diastolic dip-late diastolic plateau, characteristic of restrictive disease, appeared after cardiac surgery. In one patients cardiac constriction developed less than 2 weeks after surgery, and loculated clotted and unclotted viscous blood was removed from the pericardial space. In the other two patients the pericardial space was obliterated by dense adhesions. Thus constrictive pericarditis should be considered in postoperative patients who either do not recuperate satisfactorily after surgery or whose condition deteriorates after initial recovery.

Aged↗

PubMed1979

Constrictive pericarditis after myocardial revascularization: report of three cases.

Although postoperative constrictive pericarditis is rare, the diagnosis should be considered when unexplained right-sided heart failure develops after cardiac surgery. Within a 6 week interval, evidence of constrictive pericarditis developed in three patients who had recently undergone myocardial revascularization. One patient presented with biventricular failure, pericardial effusion and suspected tamponade. Severe constrictive pericarditis was demonstrated at subsequent operation. An apparent postpericardiotomy syndrome preceded evidence of right heart failure in the other two patients. Etiologic considerations include the possibility that pericardial irrigation with povidone-iodine (Betadine) solution may have contributed to subsequent fibrosis.

Cardiac Catheterization↗

PubMed1980

Unusual complications of epicardial pacemakers. Recurrent pericarditis, cardiac tamponade and pericardial constriction.

Three patients with unusual complications after insertion of an epicardial pacemaker are described. In one patient pericarditis and severe cardiac tamponade developed that required emergency pericardiocentesis 8 weeks after pacemaker insertion. No evidence of myocardial perforation was observed at operation. In another patient two unusual complications developed: (1) migration of the pulse generator from the epigastric site of implantation into the pelvis, and (2) recurrent pericarditis with occult signs of constriction. In another patient recurrent pericarditis and clinical evidence of constriction developed. All three patients required pericardiectomy. Recurrent pericarditis after insertion of an epicardial pacemaker requires careful medical follow-up because either life-threatening tamponade or chronic constrictive pericarditis may develop.

Adult↗

PubMed1995

Defibrillator patch electrode constriction: an underrecognized entity.

Pericardial constriction associated with the placement of intrapericardial defibrillator patches is a rare occurrence that is reported only one tenth as often in defibrillator patients as in patients undergoing other types of cardiac operations. Although this discrepancy may be attributable to a lower incidence of constriction with the defibrillator patch electrode procedure, it may also indicate a failure to recognize that progressive right heart failure and signs of low cardiac output that could be due to pericardial constriction and not progressive systolic dysfunction. Because surgical removal of the patches and decortication of the epicardial surface is the only effective therapy, it is important to recognize this uncommon, but profoundly debilitating entity.

Adult↗