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PubMed1993

Recent atrial fibrillation in acute myocardial infarction: a sign of pericarditis.

The association between recent atrial fibrillation during the course of acute myocardial infarction and pericarditis or pericardial effusion occurring during the hospital phase of myocardial infarction was studied by means of serial echocardiographic examinations in 192 patients presenting with their first myocardial infarction. Clinical pericarditis was found in 8%, echocardiographic effusion in 43%, and atrial fibrillation in 5% of all patients. Atrial fibrillation was present in only 2% of patients without pericardial effusion compared to 15% of patients with more than minimal effusion (p = 0.0094). Thus, pericarditis might play a role in the development of recent atrial fibrillation during the course of myocardial infarction. Recent atrial fibrillation may be a sign of pericardial effusion which may be otherwise silent.

Atrial Fibrillation↗
PubMed1993

[A case of constrictive pericarditis following graft replacement of the descending aorta under left ventricular bypass using a centrifugal pump].

We experienced a case of constrictive pericarditis following replacement of the descending aorta. It has been pointed out that constrictive pericarditis can be developed following LV bypass using centrifugal pump due to the cardiotomy. But no actual case has reported so far. The case was a 61-year-old man for whom graft replacement of the descending aorta through left thoracotomy was performed. Fever and heart failure was elicited 3 weeks after the operation, and he was diagnosed as constrictive pericarditis by chest CT and echocardiography. The reoperation was performed 39 days after the graft replacement. Anterior wall of the both ventricle and postero-lateral wall of the left ventricle were strongly adhered to the pericardium. The adhesion was entirely dissected and the thickened pericardium was resected. The post-operative course was uneventful and the patient was discharged 42 days after the reoperation.

Aorta, Thoracic↗
PubMed1993

[Clinical features of heart failure induced by pericarditis and myocarditis].

The clinical condition of heart failure induced by pericarditis is expressed as cardiac tamponade or constrictive pericarditis. In both conditions, cardiac filling is impaired either by pericardial fluid or nonelastic pericardial sac under increased diastolic pressure and cardiac output is reduced. Patients show signs of right side heart failure. Immediate pericardiocentesis or pericardiotomy is required for cardiac tamponade, and pericardiectomy is essential for constrictive pericarditis. The clinical expression of myocarditis ranges from asymptomatic state to fulminant fatal congestive heart failure. Recently, identification of viral infection, using polymerase chain reaction (PCR), has contributed to the diagnosis of myocarditis, involving cases of idiopathic congestive cardiomyopathy.

Cardiac Tamponade↗
PubMed1993

[Neoplastic pericarditis. Study by thoracotomy and biopsy in 80 cases].

Between 1969 and 1992, eighty cases of malignant pericarditis were studied by thoracotomy and biopsy, which made it possible not only to assert the diagnosis but also to dry the pericardial effusion by creating a pleuro-pericardial window. In 75 cases a cardiac tamponade of varying severity required surgical heart decompression. Pericarditis revealed the neoplasia in 53 cases and complicated a known cancer in 27 cases (23 carcinomas, 2 malignant melanomas included). In 63 cases (2 metastatic malignant melanomas, 7 sarcomas and 54 carcinomas) the disease was rapidly fatal. On the other hand, 17 patients with certain types of neoplasia revealed by pericarditis (12 with malignant lymphoma, 5 with non-encapsulated thymoma) have survived under an appropriate treatment. In addition to curing the immediately life-threatening tamponade, thoracotomy with pericardial biopsy determines the nature of the lesion and, consequently, its specific treatment.

Adenocarcinoma↗
PubMed1993

[Chronic constrictive pericarditis after heart surgery. Apropos of a case].

A case of pericarditis in a 52-year old patient following aorto-coronary shunt surgery is reported which gradually developed into chronic constrictive pericarditis. In this context, the diagnostic criteria of chronic constrictive pericarditis are recalled. The clinical criteria show little specificity; Doppler ultrasound provides good diagnostic information; CT scans and nuclear magnetic imaging can confirm the diagnostic. The post-heart surgery etiology has increased in recent years. The only real treatment is surgical and consists of pericardial decortication.

Chronic Disease↗
PubMed1996

[Purulent pericarditis].

Purulent pericarditis is diagnosed when pus is drained from the pericardial space or when bacteria are cultured from the pericardial fluid. This rare disease is often diagnosed late, when severe hemodynamic compromise develops due to pericardial tamponade. It is usually a complication of pneumonia, especially if there is empyema as well, and often follows chest surgery or chest wall infections. It sometimes appears in patients with septicemia, especially when they are debilitated or immuno-compromised. Diagnosis is aided by echocardiography. Pericardiocentesis and drainage of the pus, as well as prolonged antibiotic treatment, are mandatory. Delay in diagnosis and treatment often results in death. Some surviving patients may develop constrictive pericarditis and require pericardiectomy. We report a 73-year-old man with pulmonary lymphoma who suffered from purulent pericarditis secondary to sepsis with methicillin-resistant Staphylococcus aureus. Pericardial drainage and appropriate antibiotic treatment eventually resulted in complete recovery.

Aged↗
PubMed1996

[Subacute effusive-constrictive pericarditis accompanied with miliary tuberculosis: a case report].

With the advent and the introduction of effective antimicrobial therapy, the mortality for tuberculosis pericarditis decreased in number dramatically. The problems, however, remains in several severe cases. We have experienced a rare case of 74 year old male with subacute effusive-constrictive pericarditis accompanied with miliary tuberculosis. The patient revealed improvement immediately after early an emergent pericardiectomy. However cardiac failure recurred thereafter because of fibrous epicarditis of tuberculous inflammation. Management of subacute effusive-constrictive pericarditis as this has many problems including surgical intervention such as operative timing and indication and/or role of corticosteroids together with antituberculotic drugs.

Aged↗
PubMed1996

[Pleural exudate as presentation of constrictive pericarditis].

An exudative pleural effusion is a very infrequent form of presentation of constrictive pericarditis, and it can induce diagnostic difficulties. We present a 71 year-old woman with a pleural effusion attributed to be due to congestive heart failure which does not respond to the treatment. The pleural fluid had biochemical characteristics of an exudate. The echocardiographic study showed severe constrictive pericarditis, and after the pericardectomy the pleural effusion completely resolved. The diagnostic suspicion of constrictive pericarditis in cases of exudative pleural effusion is of special interest because an specific and effective treatment is available.

Aged↗
PubMed1996

[Chronic constrictive pericarditis apropos of 3 cases disclosed by refractory cardiac failure].

Chronic constrictive pericarditis is a difficult diagnosis and may present atypically. The authors report three clinical cases and review the diagnostic strategy of constrictive pericarditis. In these three patients, the diagnosis was finally made after one or more years of symptomatic disease and after several diagnostic work ups and ineffective treatments. In cardiac failure, pericardial calcification is often not observed on chest X-ray and Doppler echocardiography is usually the diagnostic investigation. Adiastole presents with dilatation of the vena cava and atria, contrasting with normal ventricles without major valvular disease. Doppler echocardiography enables distinction of constrictive pericarditis from restrictive cardiomyopathy: normal myocardium, thickened pericardium, specific septal motion, inspiratory increase in right ventricular dimensions, premature opening of the pulmonary valve, important variations in ventricular filling with respiration, expiratory diastolic reflux in the hepatic veins. Catheterisation confirms adiastole and may suggest a pericardial aetiology in characteristic cases, associated with only mild increases in pulmonary artery pressure. If need be, the pericardial thickening > 4 mm may be observed with magnetic nuclear resonance imaging and, when a doubt remains with respect to the diagnosis of cardiomyopathy, the absence of fibrosis on endomyocardial biopsy provides the diagnosis and indication for curative surgery: pericardectomy.

Chronic Disease↗
PubMed1997

[Colchicine treatment for recurrent pericarditis].

The treatment of the recurrent pericarditis is difficult habitually. The colchicine, antiinflammatory drug used in gouty arthritis, is effective in preventing the recurrences of acute pericarditis. We review the literature about the efficacy of colchicine in the prevention of recurrent pericarditis.

Anti-Inflammatory Agents↗
PubMed1998

[Constrictive pericarditis: an underestimated complication of thoracic injuries].

Constrictive pericarditis is a well defined clinical entity, traditionally secondary to longstanding tuberculosis. Although posttraumatic constrictive pericarditis, due to haemopericardium, is well known during the postoperative period following cardiac surgery, it is underestimated in closed chest trauma. A new case of constrictive pericarditis is reported, due to neglected chest trauma. The discussion emphasizes the need for early diagnosis and surgical treatment, which determine the general prognosis of pericardial constriction. This implies systematic investigation of all cases of chest trauma, even minor, by transthoracic, or preferable, transoesophageal echocardiography, looking for haemopericardium.

Echocardiography, Transesophageal↗
PubMed1998

[Constrictive pericarditis illustrated by an unusual case report].

Constrictive pericarditis is an uncommon condition. Previously, tuberculosis or other bacterial infections were prevalent causes, often with prominent pericardial calcification. Presently, many patients with constrictive pericarditis of other aetiologies have lesser degrees of structural changes in the pericardium. We report on a case with severe symptoms where the correct diagnosis was elusive because of absent or minimal preoperative pericardial pathology. The clinical, echocardiographic and haemodynamic features of constrictive pericarditis are reviewed. We recommend thorough echocardiographic evaluation of central haemodynamics in patients with symptoms of heart failure when the aetiology is not readily apparent (e.g. previous myocardial infarction dilated cardiomyopathy or valvular disease.

Aged↗
PubMed1998

Constrictive pericarditis presenting as unexplained recurrent pleural effusion: a case report.

Constrictive pericarditis may exceptionally present as pleural effusion of unknown origin and this form of presentation may cause diagnostic problems. We report a case of subacute constrictive pericarditis in which there were recurrent pleural effusion with no other signs of the disease and the initial echocardiographic study was nondiagnostic. For this reason the patient was initially considered to have primary pulmonary or pleural disease. On the basis of the subsequent development of signs of systemic congestion and the results of computed tomography, Doppler echocardiography and cardiac catheterization, which were consistent with constriction, it was concluded that the patient had constrictive pericarditis. A complete resolution of pleural effusion and signs of systemic congestion was observed following pericardiectomy.

Acute Disease↗
PubMed2003

Unusual presentation of purulent pericarditis: diagnostic contribution of MRI.

Purulent bacterial pericarditis is an uncommon form of infectious pericarditis, occurring usually in immunocompromised patients. It may rarely present as a nodular or tumefactive lesion, and in such cases is liable to be confused with primary and metastatic tumors. We describe the imaging features and diagnostic contribution of CT and MRI in a 68-year-old woman with mass-like purulent pericarditis.

Journal Article↗
PubMed1986

Pericarditis caused by beta-lactamase-producing Haemophilus influenzae: report of two cases in adults and review of the literature.

Two adult patients with pericarditis caused by beta-lactamase producing Haemophilus influenzae are reported and their management reviewed. Both had pharyngitis, epiglottitis, pneumonia, empyema, or septicemia and were cured with antimicrobics and pericardial drainage (one by catheter and one by surgery). Eleven previously reported cases of pericarditis caused by Haemophilus influenzae are also reviewed. In reviewing this rare cause of bacteria pericarditis, it is important to recognize the antibiotic resistance profile, the incidence of pericardial tamponade, and the use of surgical drainage. Antibiotic selection for this organism is also discussed, as well as the importance of biotyping.

Journal Article↗
PubMed1990

Myocarditis and myocardial interstitial fibrosis in constrictive pericarditis--an extended pathological spectrum?

We performed endomyocardial biopsy in six patients with constrictive pericarditis, revealing the presence of myocarditis and myocardial interstitial fibrosis in all regardless of the endocardial thickening. These findings suggest that the presence of endomyocardial involvement in the setting of restrictive heart disease should not be deemed specific for endomyocardial fibrosis when the clinical evaluation suggests constrictive pericarditis.

Endomyocardial Fibrosis↗
PubMed2006

Pericardiectomy for constrictive pericarditis: a clinical, echocardiographic, and hemodynamic evaluation of two surgical techniques.

BACKGROUND: This study was designed to compare the outcomes after total versus partial pericardiectomy clinically, echocardiographically, and hemodynamically. METHODS: Three hundred ninety-five patients undergoing pericardiectomy for constrictive pericarditis between January 1985 and December 2004 were studied. Age was 10 months to 71 years (mean, 25.1 +/- 13.4 years). Three hundred thirty-eight patients (85.6%) underwent total pericardiectomy (group I), and 57 patients (14.4%) underwent partial pericardiectomy (group II). RESULTS: Operative and late mortality rates were 7.6% and 4.9%, respectively. Preoperative high right atrial pressure, hyperbilirubinemia, renal dysfunction, atrial fibrillation, pericardial calcification, thoracotomy approach, and partial pericardiectomy were significant risk factors for death. The risk of death was 4.5 times higher (95% confidence interval: 2.05 to 9.75) in patients undergoing partial pericardiectomy. At a mean follow-up of 17.9 +/- 0.3 years (95% confidence interval: 17.3 to 18.6), actuarial survival was 83.8% +/- 0.04% in group I and 73.9% +/- 0.06% in group II (p = 0.004). At their last follow-up, 96.3% survivors of group I and 79.1% survivors of group II were in New York Heart Association class I/II (p < 0.001). CONCLUSIONS: Total pericardiectomy is associated with lower perioperative and late mortality, and confers significant long-term advantage by providing superior hemodynamics that appear to be independent of the etiology of constrictive pericarditis.

Adolescent↗