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PubMed1987

Effect of magnesium sulfate on thrombus formation following partial arterial constriction: implications for coronary vasospasm.

The antithrombogenic effect of magnesium sulfate in vivo is shown at the site of endothelial damage induced by partial coronary and carotid artery constriction. The left anterior descending coronary artery of dogs and the right common carotid artery of rabbits were subjected to partial constriction with suture thread (40-60% reduction in transluminal diameter). Distal blood flow, as measured by electromagnetic flow probe, was not reduced. Scanning electron-microscopic examination of vessels fixed by glutaraledhyde perfusion and dried by the critical-point technique showed endothelial damage at the site of partial constriction ranging from crater- and balloon-like vesicular defects to cellular desquamation. Marked platelet deposition on exposed subendothelium and microthrombi could be seen with the maximum degree of luminal protrusion reaching 30% of the luminal diameter. Animals pretreated with magnesium sulfate (50 mg/kg, i.v.) showed platelet deposition restricted to a maximum of 1 or 2 discontinuous layers of platelets with most vessels showing only isolated platelets on exposed subendothelium. Microthrombi were not seen in any of the magnesium-treated animals. It is suggested that the therapeutic implications of magnesium in ischemic heart disease might be extended from its use in certain tachyarrhythmias and in arterial spasm associated with Prinzmetal's angina to the more classic episodes of ischemic heart disease where thrombus formation plays an unequivocally major role.

Animals↗
PubMed1986

[Echocardiography in a case of acute tuberculous pericarditis which progressed to constrictive pericarditis].

A case of acute tuberculous pericarditis with massive pericardial effusion progressed to constrictive pericarditis under echocardiographic observation during one year. This 59-year-old man was hospitalized because of dyspnea. On admission, his physical examination revealed a paradoxical pulse, engorged jugular veins, hepatomegaly, and pitting edema in the pretibial regions. Chest radiography revealed an enlarged cardiac silhouette and a marked left pleural effusion. His echocardiogram showed a massive pericardial effusion. A biatrial echogram recorded by esophageal echocardiography showed a massive pericardial effusion anterior to the right atrial free wall. Echocardiography performed four months after commencing therapy revealed a reduction in the pericardial effusion, and normal motion of the interventricular septum and posterior wall. However, the motion of the interatrial septum was already abnormal and the excursion of the right atrial free wall was markedly reduced. These finding were similar to those in constrictive pericarditis, as previously reported. Eleven months after admission, both conventional and esophageal echograms showed findings typical of constrictive pericarditis. Thus, in this case, the abnormal biatrial dynamics were recognized earlier than the abnormal left ventricular wall motion.

Echocardiography↗
PubMed1987

Chylous ascites caused by constrictive pericarditis.

Chylous ascites is an uncommon clinical entity associated with lymphatic obstruction usually caused by underlying malignancy. The authors describe a patient with chylous ascites caused by constrictive pericarditis in the absence of mechanical lymphatic obstruction. Pathophysiological mechanisms for the development of chylous ascites in constrictive pericarditis include augmented lymph production and high impedance to lymph drainage caused by central venous hypertension. After pericardiectomy, the patient's ascites and edema resolved. Constrictive pericarditis should be considered a rare but potentially curable cause of chylous ascites.

Chylous Ascites↗
PubMed1986

[Features of the course and evaluation of the efficacy of surgical treatment of adhesive pericarditis with constriction].

Two groups of patients with constrictive pericarditis were identified on the basis of clinical and instrumental examination including echocardiography and computerized tomography of the heart: patients with complete obliteration of the pericardial sac and constriction, and those with exudative/adhesive pericarditis and constriction. Part of the patients were subjected to subtotal pericardectomy. An improvement of left-ventricular diastolic function and hemodynamic parameters was demonstrated 1 to 1.5 months after the operation. Postoperative echocardiography showed persistent disorders of interventricular septum movement and multilayer abnormal echoes in the left-ventricular posterior wall area.

Adult↗
PubMed1979

Congenital annular constrictions and intrauterine amputations revisited.

The etiology of annular constrictions and/or intrauterine amputations is believed to be the result of an embryologic developmental defect or of a happenstance mechanical constriction. Evidence drawn from 3 infants and 1 fetus is used to evaluate the above theories. It is concluded that simple mechanical constriction is most likely not the etiology, and that a focal degenerative process is operative, which is consistent with the changes originally described by Streeter. In view of present embryologic concepts, this lesion is not a primary embryologic defect as postulated by Streeter, but a secondary superimposed disease process of unknown etiology.

Abortion, Spontaneous↗
PubMed1984

Constrictive pericarditis following myocardial revascularization. A case report.

The occurrence of constrictive pericarditis after coronary bypass surgery is rare and clinical manifestations may appear at variable intervals after surgery. Three possible causes have been postulated, all of which were probably involved in the case which we describe. The clinical diagnosis of postoperative constriction is difficult and not often considered. It is best confirmed by means of cardiac catheterization, which shows typical haemodynamic features. Surgical treatment is both difficult and a threat to the coronary bypass grafts, when present. Conservative management with diuretics is preferred unless constriction is severe.

Cardiac Catheterization↗
PubMed1981

[Constrictive pericarditis secondary to myocardial infarction. Surgical care].

The authors report the case of anteroseptal myocardial infarction, complicated by a late pericardial reaction (5th - 10th week), the development of an aneurysm, and, above all, refractory ascites (12th week) found to be secondary to constrictive pericarditis. Pericardectomy and partial resection of the aneurysm were performed. Constrictive pericarditis is rare after myocardial infarction and its relationship to a forme fruste of Dressler's syndrome remains uncertain. The pathogenesis of the constriction is unknown. This complication (only reported once previously) should be recognised because of the surgical management it implies.

Adult↗
PubMed1981

Rheumatic constrictive pericarditis. A case report and review of the literature.

A case of calcific constrictive pericarditis in a young White woman with a convincing history of previous acute rheumatic fever complicated by a possible valvular lesion is presented. Cardiac catheterization confirmed the suspicion of significant cardiac compression. Successful pericardiectomy was carried out, but microscopical examination of the excised pericardium failed to demonstrate a cause. In view of the strong past history of acute rheumatic fever and mild mitral insufficiency demonstrated at cardiac catheterization, the author proposes that the calcific constrictive pericarditis was of rheumatic origin. A review of the literature on the association between rheumatic infection and constrictive pericarditis follows.

Adult↗
PubMed1981

Constriction of the umbilical cord as a cause of fetal demise following midtrimester amniocentesis.

Two cases of constriction of the umbilical cord resulting in fetal demise following midtrimester amniocentesis are presented. In both cases, real-time ultrasonography prior to amniocentesis revealed a viable fetus. Fetal demise was identified immediately following the procedure in the first case and one month later in the other. A localized constriction at the fetal end of the umbilical cord in both, with torsion of the constricted segment in the second case, was observed. Wharton's jelly was noted to be deficient in this segment of the cord in the first case. The mechanism of fetal demise is discussed. It is suggested that this abnormality should be considered when fetal demise follows midtrimester amniocentesis.

Adult↗
PubMed1981

[Permanent constrictions of the jaws (author's transl)].

Permanent constrictions of the jaws are of various types depending on the site of the lesion: temporomaxillary ankylosis, extra-articular constrictions of bone, skin, muscle, or mucosal origin, and those arising from tumors. The commonest cause is injury, those due to infection being currently less frequently observed, which cannot be said for those of tumoral origin. The consequences are difficulty in taking foud and poor buccodental hygiene, while temporomaxillary ankylosis in children provokes mandibular growth disturbances. Surgical treatment is aimed at removing the constriction. Total resection of the ankylosed block is essential to avoid recurrences, while reeducation of buccal opening must be started early and continued for long periods in all cases.

Ankylosis↗
PubMed1980

[Latent chronic constrictive pericarditis. Rapid filling overload for an accurate hemodynamic diagnosis (author's transl)].

Chest roentgenogram showed a pericardial calcification in a patient with inconspicuous signs of cardiac disease and normal basal pressures in the right cavities. A typical hemodynamic tracing of chronic constrictive pericarditis was obtained with rapid filling overload. The uncommeness of silent chronic constrictive pericarditis is mentioned and the usefulness of rapid filling overload for an accurate hemodynamic diagnosis of this condition is emphasized. Denomination of "latent" chronic constrictive pericarditis for similar cases to this reported is proposed.

Chronic Disease↗
PubMed1995

[A case of recurrent constrictive pericarditis complicated with atrial septal defect].

A case of recurrent constrictive pericarditis complicated with atrial septal defect (ASD) was operated successfully at our institute. ASD was missed at the time of the first operation. The combination of ASD and constrictive pericarditis is rare and this case is the fifth reported one in Japan. Difficulty in diagnosis of ASD and operative procedure for recurrent constrictive pericarditis are described and discussed.

Heart Septal Defects, Atrial↗
PubMed1994

[Chronic constrictive pericarditis. A retrospective study of a series of 84 patients].

Chronic constrictive pericarditis still poses diagnostic and therapeutic problems. A series of 84 cases (59 men-25 women; men age: 46 years) operated between 1979 and 1989 at the Pitié Hospital was reviewed. The majority of patients (72%) were in functional Classes III or IV; 88% had clinical signs of right ventricular failure and 18% had anasarca. The average duration of symptoms before diagnosis was 20 months. Chest X-ray showed pericardial calcification in 40% of cases. A characteristic dip-plateau pressure tracing was obtained in 76% of cases. A specific aetiology was only found in 36 cases (45%), only 12% being of tuberculous origin. A subtotal pericardectomy from phrenic to phrenic was carried out in 75 patients. The absence of planes of cleavage in 9 cases imposed a special operative technique consisting of "patchwork" sectioning of the visceral pericardium. The operative mortality was 2.3% (2 patients: pulmonary embolism and septicaemia). Non-fatal post-operative complications occurred in 8.2% of cases (7 patients). The survival rate excluding operative mortality was 94% at 3 years and 87% at 7 years. No patient was reoperated for recurrent constrictive pericarditis. At the last follow-up appointment, all patients were in functional Classes I or II. The authors conclude that the absence of specific symptoms, the low prevalence of the condition and the change in aetiology related to the decline in tuberculous infection make the diagnosis of chronic constrictive pericarditis very difficult. The diagnostic contributions of new imaging techniques such as CT and MR scanning should be assessed. This series confirms the efficacy of surgical treatment by subtotal pericardectomy.

Adult↗
PubMed1994

[Calcified constrictive pericarditis in an adolescent].

The authors report the case of an adolescent with no previous medical history with calcific pericarditis which rapidly progressed to constriction. The disease was diagnosed several months after an episode of chest pain very suggestive of acute viral pericarditis. Surgery was necessary and resulted in a complete cure of the constrictive pericarditis. The aetiologies of constrictive pericarditis are reviewed; previously, tuberculosis used to be the most common cause but it is being progressively supplanted by other pathologies.

Adolescent↗
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↗
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↗
PubMed1998

Effect of nitroprusside on arteriolar constriction after retinal branch vein occlusion.

PURPOSE: The development of extended areas of nonperfused capillaries after branch vein occlusion (BVO) is correlated to the secondary constriction of the arteriole crossing the occluded area. The decrease in nitric oxide (NO) in tissue that occurs early after BVO accounts for the secondary arteriolar constriction. The present study shows that the administration of an NO donor can reverse the secondary arteriolar vasoconstriction observed after BVO. METHODS: Simultaneous preretinal NO profiles and arteriolar diameter measurements were performed in miniature pigs after experimental BVO. The effect of preretinal microinjections of the NO donor sodium nitroprusside (SNP) on the arteriolar diameter was studied. RESULTS: Significant arteriolar vasoconstriction (mean arteriolar diameter, 92.1% +/- 3.3% of control; n = 7; P = 7.4 x 10(-5)) and a simultaneous decrease in the preretinal NO concentration ([NO]) (preretinal [NO], 20% +/- 15.6% of control; n = 5; P = 0.0003) were observed 4 hours after BVO. Microinjection of the NO donor SNP (1 mM applied by puffer) near the constricted retinal arteriole caused a segmental, reversible arteriolar dilation that reached its maximum 20 minutes after the injection (mean arteriolar diameter; 110.8% +/- 7.5% of control; n = 6; P = 0.02) and was completely reversed 60 minutes later (n = 6). CONCLUSIONS: Local administration of NO donors may contribute to the restoration of the retinal arteriolar blood flow after BVO and thus may improve the supply of oxygen and nutrients to the injured tissue.

Animals↗