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PubMed1998

[A case of constrictive pericarditis with atrial fibrillation after mitral valve repair and Maze III procedure].

We report a case of constrictive pericarditis with atrial fibrillation after mitral valve repair and the Maze III procedure. A 66-year-old male underwent mitral valve repair and the Maze procedure for mitral valve regurgitation and chronic atrial fibrillation. About 4 months after discharge, he suffered from shortness of breath. Physical examination revealed a heart rate of 80 beats/min with irregular rhythm, external jugular venous dilatation and abdominal ascites. Electrocardiography revealed atrial fibrillation, and chest X-ray revealed moderate left pleural effusion. Computed tomographic images of the chest showed a that thickened pericardium. A distinct diastolic dip and plateau pattern were recognized on cardiac catheterization. The right atrial, right ventricular end-diastolic, and pulmonary wedge pressures were elevated. Idiopathic pericarditis and recurrent atrial fibrillation were diagnosed and pericardiectomy was performed through a median sternotomy incision. Intraoperatively, the atrial fibrillation converted spontaneously to sinus rhythm. The postoperative hemodynamics improved after pericardiectomy. Total pericardiectomy alone may not convert the rhythm to sinus rhythm in patients with constrictive pericarditis and chronic atrial fibrillation. In this case, atrial fibrillation converted to sinus rhythm during the procedure. This case report suggests that adequate unloading of atrial pressures is necessary for the maintenance of sinus rhythm in patients who have undergone the Maze procedure.

Aged↗
PubMed2002

Osteoporosis following chronic constriction injury of sciatic nerve in rats.

Osteopathic changes sometimes occur in patients with complex regional pain syndrome (reflex sympathetic dystrophy and causalgia). We aimed to investigate whether such osteopathic changes occurred in rats with chronic constriction injury (CCI) of the sciatic nerve. A CCI of the sciatic nerve was established in a unilateral hind limb in 39 adult Sprague-Dawley rats, which were killed 1, 2, 3, 5, or 7 weeks after the CCI procedure. Bone mineral content (BMC) and bone mineral density (BMD) in extracted tibial bones were measured using a dual-energy X-ray absorptiometer, and the number of osteoclasts in the metaphyseal regions was counted by the use of tartrate-resistant acid phosphate (TRAP) staining. BMC was significantly decreased, compared with that of the contralateral side, 1 to 7 weeks after CCI, and BMD was decreased 2 to 7 weeks after the procedure in the ipsilateral tibial bones, compared with BMD in the contralateral bones. The number of TRAP-positive multinucleated osteoclasts in the ipsilateral bones was significantly increased at 2, 3, and 5 weeks after the CCI, when compared with the number of these osteoclasts in the contralateral bones. The results of the present study demonstrate that osteopathic changes are associated with chronic constrictive injury of the sciatic nerve.

Animals↗
PubMed1975

Constrictive pericarditis in procainamide-induced lupus erythematosus syndrome.

A rare case of constrictive pericarditis in procainamide-induced lupus erythematosus syndrome is reported. After 6 months of procainamids therapy fever, pleuritic chest pain, arthralgia and muscle soreness developed in a 47 year old man. These symptoms were soon followed by the onset of acute pericarditis and rapidly accumulating massive pericardial effusion. After withdrawal of procainamide therapy and administration of corticosteroids in large doses, there was marked subjective improvement and rapid reduction in pericardial effusion. However, constrictive pericarditis with massive leg edema and ascites developed 6 weeks after admission as corticosteroid therapy was gradually discontinued. These manifestations subsided after pericardiectomy was performed.

Humans↗
PubMed1980

Early diastolic sound of constrictive pericarditis.

In two patients with constrictive pericarditis an absent or faint early diastolic sound became prominent with squatting, phenylephrine infusion or injection of contrast medium and was obliterated by nitroglycerin. The lability of the sound allowed correlations to be made with acute changes in the right ventricular pressure curve. By eliciting an otherwise inaudible early diastolic sound, squatting may be a useful bedside maneuver in the diagnosis of constrictive pericarditis.

Adult↗
PubMed1980

Clotted hemopericardium with the hemodynamic characteristics of constrictive pericarditis.

Cardiac catheterization in a patient 4 weeks after coronary arterial bypass surgery demonstrated the typical hemodynamic findings of constrictive pericarditis, which completely resolved after removal of 500 ml of clotted pericardial blood. The pericardium was not responsible for the findings because it was left in place. This case demonstrates that clotted hemopericardium may mimic constrictive pericarditis.

Aged↗
PubMed1982

Immune reactions in tuberculous and chronic constrictive pericarditis. Clinical data and diagnostic significance of antimyocardial antibodies.

Humoral immune reactions were analyzed in 12 patients with exudative tuberculous pericarditis, 10 patients with constrictive pericarditis due to former tuberculosis, 10 patients with viral pericarditis, 20 patients with pulmonary tuberculosis, and 98 healthy donors. Pericarditis occurred in 12.5% of the patients with tuberculosis, whereas the incidence of tuberculosis in the 149 patients with pericarditis was 8%. Repeated pericardial puncture and pericardial effusions of greater than 500 ml with impending cardiac tamponade had to be performed in 4 patients. Clinical data indicated probable myocardial involvement in 4 of 12 patients. Antimyolemmal antibodies, which are a muscle-specific subtype of antisarcolemmal antibodies, were found in all patients with exudative tuberculous pericarditis and viral perimyocarditis, in only 1 of 12 patients with constrictive pericarditis, and in no patients with pulmonary tuberculosis. Antifibrillary antibodies--primarily of the antimyosin type--were missed in patients with viral heart disease but were demonstrated in 75% of patients with tuberculous pericarditis. Only sera with complement-fixing antimyolemmal antibodies of the IgG type in titers greater than 1:40 induced cytolysis of vital adult heterologous cardiocytes isolated and enriched by silica sol gradient centrifugation. These findings suggest not only that antimyolemmal antibodies are diagnostic indicators of perimyocardial involvement in tuberculous pericarditis, but also that they may play a significant role in its pathogenesis.

Antibody Specificity↗
PubMed1982

Constrictive pericarditis: new aspects.

The current status of constrictive pericarditis is reviewed with regard to its etiology, physical signs, electrocardiographic findings, and hemodynamic features. Angiographic aspects are also presented. The role and limitations of M-mode echocardiography in this disease are emphasized. The value of other noninvasive studies such as measurement of systolic time intervals, myocardial scanning, and high-speed echocardiography is described. Emphasis is placed on the invasive and noninvasive methods that may be useful in separating restrictive cardiomyopathy from constrictive pericarditis. Methods of treatment, indications for pericardial resection, and the current operative results are commented on briefly.

Angiocardiography↗
PubMed1985

Magnetic resonance imaging of constrictive pericardial disease.

Gated magnetic resonance imaging of 5 patients with suspected constrictive pericardial disease was performed using a superconducting magnet operating at 0.35 Tesla. Results were compared with those of echocardiography and hemodynamic measurements in all patients, with chest films in 5, computerized tomography in 2 and with histologic findings in 3. Pericardial thickness exceeded 5 mm in 4 patients and was 5 mm in 1 patient. Absence of magnetic resonance signal from the thickened pericardium was observed with extensive calcific deposits, and increased intensity of the thickened pericardium was associated with inflammatory disease. Dilatation of the right atrium, venae cavae and hepatic veins, and right ventricular narrowing was observed in all patients. The ventricular septum was straight in all patients. Magnetic resonance imaging allows both measurement of pericardial thickness and depicts internal cardiac anatomy without exposure to radiation or use of contrast medium. Satisfactory imaging with a large field of view can be performed in the presence of lung disease, thoracic deformity or surgical "hardware"--conditions that limit echocardiography and computerized tomography. The inherently 3-dimensional data permit imaging in any plane without loss of resolution. Thus, magnetic resonance appears to be the noninvasive method of choice for the diagnosis of constrictive pericardial disease.

Calcinosis↗
PubMed1990

Futility of pericardiectomy for postirradiation constrictive pericarditis?

Two patients underwent pericardiectomy for postirradiation constrictive pericarditis. Both had received radiotherapy (more than 6,000 rads) for treatment of Hodgkin's disease 17 (patient 2) and 20 years (patient 1) earlier. At the time of operation, the patients were in New York Heart Association functional class III-IV or IV. Preoperative catheterization showed the following pressures for patients 1 and 2, respectively: right atrial, 30 and 14 mm Hg; right ventricular end-diastolic, 28 and 14 mm Hg; wedge, 29 and 13 mm Hg; and left ventricular end-diastolic, 27 and 14 mm Hg. Complete epicardiectomy and pericardiectomy was attempted in both patients. However, hospital mortality was 100%; patient 1 died of multiorgan failure after six days, and patient 2 died of biventricular failure after 3 months. A review of the literature revealed 44 cases of pericardiectomy for postirradiation constrictive pericarditis and a late survival rate of less than 50%. The poor results in these patients compared with patients having pericardiectomy for other reasons seem to be due mainly to the various kinds of radiation-induced damage to the heart as a whole, including untimely coronary artery disease, myocardial fibrosis, atrioventricular conduction disturbances, and valve dysfunction, with the result that complete relief by epicardiectomy and pericardiectomy may not be technically feasible.

Adult↗
PubMed1991

Pericardial mass mimicking constrictive pericarditis.

Persistent pericardial hematoma due to blunt chest trauma is extremely rare. We report a case of constricted myocardium resulting from a large, partially organized hematoma in the right cardiophrenic angle. The hematoma was assumed to be caused by an occupational accident 17 years before diagnosis. Constriction could only be controlled by complete removal of the fibrous posterior capsule of the hematoma, which covered the epicardium of the right heart.

Aged↗
PubMed1994

Mitral insufficiency after pericardiectomy for constrictive pericarditis.

We report the case of a 24-year-old man in whom a clinical syndrome developed while he was on active military duty in Saudi Arabia that was subsequently diagnosed as constrictive pericarditis. Phrenic nerve to phrenic nerve pericardiectomy and posterior pericardial release successfully relieved the ventricular constriction with a resultant increase in the cardiac index from 1.9 to 3.8 L.min-1.m-2. Transesophageal echocardiographic monitoring during the operation disclosed trace mitral regurgitation before median sternotomy. The severity of the regurgitation noticeably increased to the moderate level immediately after pericardial resection. This echocardiographic finding had improved 1 week later, but the regurgitation still was greater than baseline. Mitral valve function had returned to baseline by 4 weeks after the operation. Possible mechanisms of this evolving pattern of perioperative mitral valve dysfunction are discussed.

Adult↗
PubMed1988

The amniotic band disruption complex. The pathogenesis of congenital limb ring-constrictions; an experimental study in the foetal rat.

This paper reports the findings of an experimental foetal rat study which has shown that it is possible to produce mild, moderate and severe limb ring-constrictions by simulating the ligature effect of amniotic bands. Of the 40 experimental foetuses, 36 (90%) survived the in utero surgery and are included in the present study. Of these 36 foetuses, limb constriction rings were produced in 35 (97%), and an in utero limb amputation in one (3%).

Amniotic Band Syndrome↗
PubMed1991

Endothelin-1, -2 and -3 directly and big-endothelin-1 indirectly elicit an abdominal constriction response in mice.

When injected intraperitoneally into mice, endothelins ET-1, ET-2, ET-3 and big-endothelin-1[1-38] (big-ET-1[1-38]) produced a dose-related, robust and easily quantified abdominal constriction response within 20 min. The ED50 values for this response were 0.026, 0.005, 0.131, and 0.043 mg/kg, respectively. Hence, this test could provide a convenient in vivo endpoint for endothelin activity. The results also imply that ET-1, ET-2, ET 3 or big-ET-1[1-38] may be nociceptive under certain conditions. Morphine (4 mg/kg, s.c.) administered 30 min prior completely blocked the response produced by ET-1. Thus, in conjunction with other indicators, the test may also serve as an in vivo screen for agents useful in the treatment of abdominal or visceral pain. The effect of big-ET-1[1-38], but not ET-1, was blocked by pretreatment with the enzyme inhibitor phosphoramidon (10 mg/kg, s.c., 30 min prior), implying that the big-ET-1[1-38] must first be enzymatically cleaved, presumably to ET-1, in order to elicit the abdominal constriction response. This test might also serve as a discriminative antinociceptive screen, because the response to ET-1 was not blocked by acetaminophen (400 mg/kg, p.o.), ibuprofen (75 mg/kg, p.o.) or indomethacin (1.0 mg/kg, p.o.).

Abdomen↗
PubMed1995

Constriction of the fetal ductus arteriosus during prenatal betamethasone therapy.

BACKGROUND: Constriction of the fetal ductus arteriosus occurs with maternal indomethacin treatment and has been suggested with corticosteroid therapy as well. CASE: Fetal ductal constriction was diagnosed by Doppler echocardiography at 29 weeks' gestation after a third and fourth course of betamethasone was administered to a pregnant woman with placenta previa. Doppler echocardiography showed a patent ductus arteriosus 3 days after the treatment. CONCLUSION: The risk-benefit ratio of betamethasone should be assessed by large-scale studies when repeated courses or chronic maternal administration of betamethasone are required.

Adult↗
PubMed1994

Prospective comparison of topical minoxidil to vacuum constriction device and intracorporeal papaverine injection in treatment of erectile dysfunction due to spinal cord injury.

OBJECTIVE: To compare the effectiveness of topically applied 2% minoxidil to that of intracorporeal injection therapy and vacuum constriction devices for the treatment of erectile dysfunction in the spinal cord injured (SCI) male. METHODS: Eighteen SCI men, aged nineteen to sixty-five years (median age, 29), and level of injury C7 to L3 (15 thoracic level) were prospectively evaluated. All patients were able to achieve only a poorly sustained reflex erection that was inadequate for satisfactory intercourse. No patient had suffered erectile dysfunction prior to his SCI. In each patient, 1 mL of a 2% minoxidil solution was applied as an aerosol spray to the glans penis. The erectile response was compared to that obtained with a vacuum constriction device (VCD) and intracorporeal papaverine injection. In each case, the subjective assessment by both the patient and the physician, as well as objective results of penile base rigidity as measured by the RigiScan DT Monitor Device, were recorded. RESULTS: Papaverine increased rigidity at the base of the penis by a median 77 percent (range, 30-100%). The VCD increased rigidity by a median 57 percent (range, 30-80%). Minoxidil induced no change in rigidity (range, 0-15%). No complications were observed for any method of inducing tumescence. CONCLUSIONS: Papaverine and VCD proved to be effective means of establishing penile erection in male SCI patients. Both subjective and objective erectile responses to minoxidil were poor. Nevertheless, the principle of topical therapy is an attractive alternative to existing modalities. Further investigation is warranted.

Administration, Topical↗
PubMed1984

Renal arachidonic acid metabolism and cellular changes in the rabbit renal vein constricted kidney: inflammation as a common process in renal injury models.

The process of renal inflammation was examined using the partial renal vein constricted rabbit kidney ( RVC ) as a model. Forty eight hours of partial renal vein constriction in the rabbit was associated with an increase in prostaglandin (PG) and thromboxane (Tx) production. The ex vivo perfused RVC kidney showed an enhanced time-dependent increase in PG and Tx production in response to bradykinin stimulation when compared with the unaltered contralateral ( CLK ) or normal kidney. At 6 hrs of perfusion bradykinin stimulation released 2950 +/- 350 ng PGE2, 61 +/- 15 ng TxB2 from the RVC , and 225 +/- 85 ng PGE2 and undetectable TxB2 from the CLK . Histological examination of the RVC cortex showed an increase in fibroblast-like cells, a modest increase in the interstitial space and an appearance of macrophages and lymphocytes not seen in the normal or CLK . Endotoxin has been reported to stimulate macrophages in culture to produce PGE2 and TxB2. Endotoxin (100 ng) stimulation of the perfused RVC kidney caused an immediate, followed by a chronically increasing, release of PGs and Tx. Two hours after endotoxin injection 50 ml of effluent from the RVC contained 1450 +/- 107 ng PGE2 and 15.0 +/- 4.5 ng TxB2. Other animals of renal inflammation (e.g., the hydronephrotic kidney, chronic glomerulonephritis) also show the histological appearance of macrophages. In addition, hydronephrotic kidneys undergo fibroblast proliferation and changes in arachidonic acid metabolism similar to that we observed in the RVC . This work suggests that the inflammatory process (mononuclear cell infiltration, fibroblast-like cell proliferation, and accompanying changes in arachidonate metabolism is common among different forms of renal injury.

Animals↗
PubMed1986

Rapid-acquisition computed tomography demonstration of chronic calcified pericardial constriction.

Dynamic imaging by a new ultrafast computed tomography scanner of a patient with chronic calcified pericardial constriction is presented. Images of the heart throughout the cardiac cycle demonstrate compression of the right ventricle by calcified pericardium. Hemodynamic data was derived from the scan study to support the diagnosis of pericardial constriction, which was confirmed on cardiac catheterization.

Aged↗
PubMed1983

Constrictive pericarditis following cardiac surgery; a complication that does exist.

Constrictive pericarditis as a complication of cardiac surgery does exist. Although the problem is somewhat uncommon, it should be suspected in patients following cardiac surgery who present with deteriorating cardiac function. The clinical spectrum of the disease is wide and may present as true rigid shell constriction or a more subtle form of elastic sero-effusive construction. It is imperative for the physician to consider this entity in the differential of complications following cardiac surgery.

Adult↗