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PubMed1980

Recent experience with tuberculous pericarditis.

Twelve patients with tuberculous pericarditis were found among 1,194 patients with tuberculosis treated at the University of Texas Medical Branch over a 10-year period, an incidence of 1%. Surgical treatment was undertaken in 4 patients, and the rest were treated medically. The surgically treated patients had no major complications, and none of them died. In the medically treated group, however, 1 patient died, 1 had an anaerobic empyema, and 1 experienced respiratory arrest. In addition, the average hospital stay was 33 days less in the surgically treated group. Early surgical intervention should be carried out in patients with tuberculous pericarditis who do not respond promptly to adequate antituberculosis chemotherapy.

Adult↗
PubMed1987

Controlled trial of prednisolone as adjuvant in treatment of tuberculous constrictive pericarditis in Transkei.

In Transkei, 143 patients with active tuberculous constrictive pericarditis without significant pericardial effusion all received the same daily 6-month antituberculosis regimen of streptomycin, isoniazid, rifampicin, and pyrazinamide for 14 weeks followed by isoniazid and rifampicin. They were randomly allocated to receive in addition either prednisolone or placebo for the first 11 weeks; the comparison was double-blind throughout treatment and follow-up. In the 114 patients assessable up to 24 months, improvement was significantly more rapid in the prednisolone group, as shown by the rate of fall in the mean pulse rate and the rate at which jugular venous pressure and level of physical activity became normal. During follow-up, 2 (4%) of the 53 prednisolone and 7 (11%) of the 61 placebo patients died from pericarditis, and 11 (21%) and 18 (30%), respectively, required pericardiectomy. By 24 months 50 (94%) prednisolone and 52 (85%) placebo patients had a favourable status. 3 patients (1 prednisolone, 2 placebo) were normally active but were classified as not having achieved a favourable status. It is recommended that, in the absence of a specific contraindication, antituberculosis chemotherapy should be initially supplemented by steroids.

Adolescent↗
PubMed1994

Treatment of exudative fibrinous pericarditis with intrapericardial urokinase.

Three male patients with purulent pericarditis, in whom complete drainage could not be obtained by pericardiocentesis, were treated with transcatheter intrapericardial urokinase to prevent the development of chronic constrictive pericarditis. As shown by echocardiography, the intrapericardial fibrin layers disappeared in two cases and were reduced by more than half in the third. Effects on systemic coagulation indices and complications related to intrapericardial lysis were not observed.

Adult↗
PubMed2005

[Ascites due to constrictive pericarditis].

INTRODUCTION: We report a case in which ascites revealed chronic constrictive pericarditis (CCP) of tuberculous origin. OBSERVATION: A 65 year-old man had developed ascites the past over few weeks and oedema of the lower limbs. Treatment was surgical and consisted in pericardiectomy. DISCUSSION: Chronic constrictive pericarditis has become rare in industrialised countries with the reduction in the incidence of tuberculosis. Currently, its principle aetiologies identified are previous cardiac surgery and radiotherapy. Treatment is usually surgical and gives excellent results. This clinical case clearly illustrates the interest of systematic biological analysis of ascites, since it may reveal a curable disease.

Aged↗
PubMed2001

Constrictive tuberculous pericarditis in a HIV-positive patient.

Constrictive pericarditis is a relatively rare clinical manifestation nowadays. We present the case of an HIV-positive patient with constrictive calcified pericarditis due to an infection with Mycobacterium tuberculosis. Pericardectomy was performed. The therapeutical approach is discussed and the literature is reviewed.

Adult↗
PubMed2001

Late pericarditis secondary to pericardial patch implantation 25 years prior.

We report a rare case of a 50-year-old man with signs of right heart failure due to localized pericarditis that was secondary to implantation of an artificial pericardial patch 25 years prior following pericardectomy for constrictive pericarditis. The patient's clinical symptoms resolved completely in the 3 years following patch removal.

Humans↗
PubMed2003

[Right heart failure following pericarditis constrictiva tuberculosa--urgent surgical treatment].

UNLABELLED: A 71-year-old male patient presented with a 4-month history of fever, dyspnoea, night sweat, ankle swelling and was admitted to our institution for further investigation due to heart failure (NHYA IV). A posterior-anterior chest radiograph showed an enlarged cardiac silhouette, the lung was without pathological findings; calcifications were not described. Echocardiography revealed a severe diastolic malfunction but no pericardial effusion. In computed tomography, pericardium was thickened. Patient was admitted for further investigations. Heart catheterization revealed a left ventricular ejection fraction of 56 %, a cardiac index of 1.3 ml/min/m2 leading to the diagnosis of severe constrictive pericarditis. The patient underwent an urgent pericardectomy via median sternotomy. Extracorporal circulation was not necessary. The postoperative course was uneventful, heart failure improved to NYHA II. The removed pericardium revealed severe granulomatous pericarditis resulting from infection with acid-resistant bacilli. The diagnosis was confirmed by a positive culture for mycobacterium tuberculosis. The patient was put on anti-TB chemotherapy for one year. 1 year after operation patient is graduated in NYHA class II. CONCLUSION: This rare extrapulmonary form of TB can have an insidious or sudden onset. The diagnosis is complicated by non-specific clinical and radiographic findings. Clinical presentation may be the result of the infectious process itself or the pericardial inflammation causing pain, effusion, and hemodynamic effects. In the absence of concurrent extracardiac TB, diagnosis of pericardial TB is difficult. Nevertheless, rapid diagnosis and treatment are crucial to reduce mortality.

Aged↗
PubMed1994

Lyme pericarditis leading to tamponade.

We report the case of a 62-yr-old man who presented with Lyme pericarditis leading to cardiac tamponade shortly followed by an arthritis. IgM and IgG antibodies to Borrelia burgdorferi were demonstrated in serum by indirect immunofluorescence. Borrelia burgdorferi was demonstrated and identified in pericardial fluid by indirect immunofluorescence using serum from a patient with proven Lyme disease and by a monoclonal antibody immuno-gold silver stain. Spirochetes were also found in synovial biopsies using a silver stain. The tamponade was treated with pericardiocentesis; the arthritis was treated with intravenous ceftriaxone (2 g once daily) for 14 days. The patient recovered completely within days of commencing treatment. This case report demonstrates that borrelial infection may lead to pericarditis and cardiac tamponade.

Arthritis, Infectious↗
PubMed1981

Gallium-67 imaging in pericarditis secondary to tuberculosis and histoplasmosis.

In recent years, many cases of Ga-67 uptake by the heart have been reported. One such case involved a patient with tuberculous pericarditis. Recently, a patient was referred to us for the investigation of a fever of unknown origin. A Ga-67 scan was performed and showed an intense uptake by the pericardium. The final diagnosis was pericarditis secondary to mediastinal lymph node involvement with tuberculosis and histoplasmosis.

Adolescent↗
PubMed1979

Infective pericarditis in Nigerian children.

53 children with infective pericarditis were seen at the University College Hospital, Ibadan, between 1967 and 1976. Their ages ranged from 10 days to 15 years but 53% of them were aged 5 years and below. Cough, fever, and breathlessness were the most common symptoms; cardiac decompensation was evident in over 30% of them, 23% had muffled heart sounds, but a pericardial friction rub was audible in only one. The main pathogens identified were Mycobacterium tuberculosis (11 cases), Staphylococcus aureus (11 cases), Escherichia coli (4 cases), Pneumococcus and Pseudomonas (3 cases each). Most of the patients had some other associated infection--such as, bronchopneumonia (12 cases), empyema thoracis (10 cases), lung abscess (10 cases), septicaemis (6 cases), and osteomyelitis (3 cases). Errors in diagnosis were common, the diagnosis having been missed in 72% of the cases identified at necropsy. Even if the correct diagnosis had been made during life and appropriate treatment given, the mortality rate (36%) was high. It is suggested that the onset of cardiac failure in any child with bronchopneumonia, empyema, or lung abscess should always arouse a suspicion of infective pericarditis.

Adolescent↗
PubMed1983

Aetiology of chronic constrictive pericarditis.

In a consecutive series of 32 cases of chronic constrictive pericarditis treated by pericardiectomy during the past 25 years, four were attributable to rheumatoid disease, two to trauma, one to sarcoidosis, and four, at a maximum, to tuberculosis. In the remaining 21 cases of undetermined aetiology there was no evidence of tuberculosis. It appears, therefore, that tuberculosis was not a common cause of chronic constrictive pericarditis during the period under review, which included the 1950s and early 1960s when tuberculosis was widespread.

Adolescent↗
PubMed1983

Inflammatory constriction following complete pericardiectomy in tuberculous constrictive pericarditis.

A 13-year-old boy with active tuberculous constrictive pericarditis underwent complete pericardiectomy together with antituberculous therapy and a short course of steroids. Six weeks following the surgery, he was seen with clinical and hemodynamic findings of recurrent pericardial constriction, presumably due to an inflammatory collection around the heart. Symptoms gradually resolved within six months with resumption of steroid therapy. Repeat hemodynamic study showed normal hemodynamics. The case demonstrates the production of cardiac constriction by nonpericardial inflammatory tissue and the possible benefits of steroid therapy in the treatment of tuberculous constrictive pericarditis.

Adolescent↗
PubMed1977

"Acute" granulomatous pericarditis. clinical and hemodynamic correlate.

Ten cases of acute constrictive pericarditis from southern Iran are presented. They differed from chronic constrictive pericarditis by the absence of ascutes and edema of the lower extremities, the presence of cardiomegaly on posteroanterior chest x-ray film, the lack of calcification of the pericardium on fluoroscopic examination, and the presence of sinus rhythm in all cases. If tuberculosis is the etiologic agent, early pericardiectomy should be considered. This is especially important in areas where close follow-up of patients is difficult or impossible, since all patients in this series ultimately developed clinically significant constriction.

Adolescent↗
PubMed1976

Nonviral infectious pericarditis.

Infections of the pericardium can occur as incidental findings in patients with systemic disease or dominate the clinical situation, representing a major threat to life. These infections appear to arise from the contiguous spread of infected tissue or from hematogenous dissemination. The clinical manifestations can resemble the "textbook description," but more often are subtle, nonspecific, or altered by the patient's basic disease. The diagnosis should never be discarded because dyspnea or chest pain are not elicited, friction rub and pulsus paradoxus are not detected, and chest x-rays and electrocardiograms are not "confirmatory." It is generally conceded that there has been a recent shift in the etiology of infectious pericarditis. This change has been attributed to the increased average age of hospitalized patients, modern diagnostic and therapeutic advances, and the impact of antibiotics. However, three concepts have stood the test of time: accurate diagnosis is the cornerstone of treatment; the availability of antibiotics must not relegate the role of surgery to a secondary position; and therapy must be directed against the pericarditis and the additional sources of infected tissue.

Bacterial Infections↗
PubMed1976

The role of pericardiotomy in treatment of pericarditis with effusion.

Experience with 23 patients with pericarditis and pericardial effusion is discussed. The methods of drainage with their relative merits are mentioned, as are the etiology of pericarditis, signs and symptoms of the disease as well as various techniques for establishing the diagnosis.

Adolescent↗
PubMed2003

Constrictive tuberculous pericarditis: case report and review of the literature.

Constrictive pericarditis is a rare disease characterized by the encasement of the heart by a rigid, non-pliable pericardium, with impaired diastolic filling of the ventricles. Its etiology is often unclear (42%), but is frequently associated with viral infection and tuberculosis, especially in developing countries. In this article the authors present the case report of a 28 year-old black woman, born and resident in Angola, with a history of tuberculosis, admitted to our hospital with global heart failure. After investigation a diagnosis of constrictive tuberculous pericarditis was established and the patient underwent pericardiectomy. Clinical features and radiologic, electrocardiographic, echocardiographic, computed tomography, nuclear magnetic resonance imaging and hemodynamic findings are discussed. This case illustrates the importance of early pericardiotomy before the appearance of pericardiectomy before end-stage pericardial fibrosis and subsequent increased possibility of an adverse postoperative outcome.

Adult↗
PubMed2006

Chronic constrictive tuberculous pericarditis: risk factors and outcome of pericardiectomy.

OBJECTIVE: Data on long-term outcome of pericardiectomy are limited. This retrospective study aimed to investigate risk factors and early and late outcomes of pericardiectomy for constrictive tuberculous pericarditis. DESIGN: Seventy patients with chronic constrictive pericarditis who underwent pericardiectomy between January 1990 and August 2005 were reviewed for perioperative and long-term survival. RESULTS: Patients (49 males; median age 40 years) had a median duration of symptoms of 24 months (range 8-72) before surgery. Perioperative mortality was 8.6%. During follow-up (mean 66.4 +/- 56.4), late mortality rates at 5 and 10 years were 1.6% and 9.7%, respectively. The mean censored survival in all patients was 155.2 months (SEM 8.3, 95%CI 138.8-171.6). Readmission-free survival was 68.6% over 10 years (mean 125.4 months, SEM 10.3, 95%CI 105.2-145.6). Ascites and duration of symptoms were found to be predictors of perioperative mortality (P = 0.047 and 0.036, respectively). CONCLUSIONS: The optimal time of pericardiectomy is most important in its management. Total or near-total pericardiectomy should always be performed as early as possible.

Adolescent↗
PubMed1980

[Difficulties and errors in diagnosing exudative pericarditis].

The peculiar features of the course of atypical variants of pericarditis with effusion are considered on the basis of concrete clinical cases, and the informative value of some symptoms and their reliability in making the diagnosis are discussed. Examples are given of patients with adhesive pericarditis with effusion some of whom developed heart tamponade with fluid in the formation of a non-stretchable external capsule and others had compression by the internal capsule.

Aged↗