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Pericarditis due to interferon alpha therapy during treatment for chronic hepatitis C. We report a patient with pericarditis during therapy with interferon alpha 2b for chronic hepatitis C viral infection. We review interferon alpha therapy and hepatitis C virus side-effects on the cardiovascular system.
In the antibiotic era, purulent pericarditis, an infection associated with high mortality, is uncommon. The causative organism is generally Staphylococcus aureus or Streptococcus pneumoniae arising from contiguous spread or hematogenous dissemination of an underlying infection elsewhere in the body. The present report describes a previously healthy individual who presented with acute infectious pericarditis with the offending organism identified as Lancefield group C Streptococcus equi. After an initial pericardial window was unable to prevent recurrent pericardial effusion, pericardiectomy was performed and the patient slowly recovered from the incident.
We reported a case of effective weekly paclitaxel administration for gastric cancer recurrence with carcinomatous pericarditis. A 69-year-old man underwent distal gastrectomy for gastric cancer in December 2001. However, he was re-admitted to the hospital for dyspnea in November 2002. A diagnosis of cardiac tamponade caused by gastric cancer relapse was made, and the patient was treated by weekly paclitaxel administration (90 mg/body) after drainage. It was effective in preventing reaccumulation of the pericardial effusion until his death 73 days after the diagnosis. It is thought that weekly paclitaxel administration can be a treatment for carcinomatous pericarditis.
Constrictive pericarditis and restrictive cardiomyopathy are 2 forms of diastolic dysfunction with similar presentation but different treatment options. Whereas constrictive pericarditis has the potential of being cured with pericardiectomy, restrictive cardiomyopathy is usually incurable. It is therefore crucial to differentiate between the 2 disorders. In the last few years, new diagnostic techniques have become available to differentiate these causes of diastolic dysfunction from each other. This review provides a complete, in-depth comparison of the 2 disorders with regard to their symptoms and clinical features, etiology, pathophysiology, hemodynamics, echocardiographic presentation, and finally the different available management options.
A 61-year-old male had complained of cough and dyspnea on effort, with right pleural effusion. Computed tomography demonstrated a calcific pericardium surrounding the entire heart, with thickening of 10 mm. Cardiac catheterization showed no coronary disease, but a dip-and-plateau of the pressure curve of both ventricles. We diagnosed congestive heart failure due to chronic constrictive pericarditis, and performed a subtotal pericardiectomy, using an Ultrasonic Scalpel through a median sternotomy combined with anterior left thoracotomy at the level of the fifth rib, without cardiopulmonary bypass (CPB). After the subtotal pericardiectomy, his postoperative recovery was uneventful and his functional status improved. We consider that our surgical technique is a useful method for treatment of chronic constrictive pericarditis, and advocate the use of the Ultrasonic Scalpel for a safe and easy pericardiectomy.
A woman presented after an illness of fever and arthralgia, with increasing shortness of breath. Investigations revealed she had effusive constrictive pericarditis, anaemia, a pulmonary infiltrate, and evidence of acute parvovirus B19 infection. Parvovirus should be considered as a cause of pericarditis, especially if there is recent arthralgia or associated anaemia.
We report a case of successful aortic root replacement using a stented bioprosthetic valved conduit and pericardiectomy in a patient with liver cirrhosis and constrictive pericarditis. A 72-year-old man treated for alcoholic liver cirrhosis was referred for the aortic regurgitation and dilatation of sinus of Valsalva. He underwent Bentall operation using a stented bioprosthetic valved conduit and pericardiectomy successfully. For patients whose anticoagulation is contraindicated, aortic root replacement using valved conduit with bioprosthesis is useful option. Concomitant pericardiectomy for constrictive pericarditis may provide better long-term results.
A case of constrictive pericarditis with PLGE is reported. It is the nineteenth case in the world literature. The fatal outcome is contributed to late diagnosis and refusal of surgery. It is possible that nine out of sixty eight cases of constrictive pericarditis have suffered from the same condition in a five year period in the same hospital. Early diagnosis is rewarding and could be achieved by a high index of suspicion and an outlook for the diagnostic markers.
The authors report the case of a 61 year-old patient treated by tetracycline for very probable Whipple's disease who developed constrictive pericarditis requiring pericardectomy. Although intestinal biopsy was negative, histological examination of the resected pericardium was very suggestive of a cardiac localisation of Whipple's disease, showing a fibrous pericarditis with a mononuclear infiltration including PAS-positive histiocytes. In addition, the same histological changes were found in a small fragment of myocardial biopsy. This case illustrates the prevalence and consequences of cardiac involvement in Whipple's disease.
OBJECTIVES: To compare the efficacy of intrapericardial corticosteroid therapy to either oral corticosteroid therapy or intrapericardial placebo in addition to closed pericardiocentesis and anti-tuberculous therapy in patients with tuberculous pericarditis. METHODS: Patients with large pericardial effusions requiring pericardiocentesis were included. A short-course anti-tuberculous regimen was initiated and patients were randomised to one of three treatment groups: 200 mg intrapericardial triamcinolone hexacetonide; oral prednisone plus intrapericardial placebo; or 5 ml intrapericardial 0.9% saline (placebo). Patients were followed up for at least one year. RESULTS: Fifty-seven patients were included in the study; 21 tested HIV positive (36.8%). Forty (70.0%) had microbiological and/or histological evidence of tuberculosis, and 17 (30.0%) had a diagnosis based on clinical and laboratory data. All patients responded well to initial pericardiocentesis. However, nine patients (16.0%) were lost to follow up. The hospitalisation duration for the steroid groups was shorter than for the placebo group. This difference was not significant. Complications were similar for all arms. CONCLUSIONS: Intrapericardial and systemic corticosteroids were well tolerated but did not improve the clinical outcome. The standard six-month regimen was effective regardless of HIV infection. The potential benefits from adjunctive corticosteroids in the management of effusive tuberculous pericarditis could not be demonstrated in this three-year study.
We report the case of a 31-year-old woman who died in a context of haemophagocytic syndrome with multiple opportunist infections:viral, mycobacterial and fungal. To our knowledge, this is the tenth case of invasive aspergillosis manifested by an aspergillus pericarditis with cardiac tamponade. Search for HIV infection, neoplasia, haematological malignancies was negative. In addition, the patient carried on a nonviral, non-ethylic cirrhosis, the etiology of which remained unknow. We will particularly develop the aspergillus pericarditis with cardiac tamponade and the haemophagocytic syndrome.
Purulent pericarditis is a rare disease that is most often caused by organisms such as Staphylococcus aureus, Streptococcus pneumoniae, viridans streptococci, Haemophilus influenzae, and anaerobic bacteria. We present an unusual case of purulent pericarditis caused by Streptococcus pyogenes, Lancefield group A streptococcus (GAS), and we provide a review of the literature.
Constrictive pericarditis (CP) following hemopericardium has been reported in the literature but its pathogenesis is open to question. Proposed mechanisms include trauma leading to damage of the mesothelial lining resulting in decreased fibrinolytic activity in the presence of blood. We present a patient who sustained blunt thoracoabdominal trauma in a car accident and subsequently developed delayed hemopericardium leading to constrictive pericarditis and impending cardiac tamponade. We performed a pericardiectomy to relieve the compression. Closely prolonged monitoring and emergent operation are suggested for such kinds of delayed complications.
61 patients were operated on for constrictive pericarditis at the Cardiovascular Surgical Clinic of Semmelweis Medical University in the last 33 years. The average hospital mortality of the surgical pericardiectomy was 4.9%. The final conclusions of this retrospective and follow up study are as follows: pericardiectomy is the method of choice in the treatment of constrictive pericarditis, since it does not has any therapeutic alternative, its hospital mortality is low and it results excellent early and late postoperative functional effects.
The case of a 60 year old patient with Parkinson's disease is reported, who, following 2 years of treatment with bromocriptine, presented a left pleural effusion in which chronic constrictive pericarditis was demonstrated. Studies aimed at establishing the etiology were negative. Upon withdrawal of bromocriptine, the pleural effusion disappeared and the patient remained asymptomatic, with only pleural thickening persisting in the thoracic radiography. The appearance of polyserositis as an undesirable effect of the use of bromocriptine is discussed. The first case associated to chronic pericarditis is reported.
Constrictive chronic pericarditis in a 13-year-old male patient was previously treated as chronic hepatitis for seven years, with the use of furosemide and spironolactone. Investigation for diagnosis included chest radiography, echo-doppler-cardiography, thoracocentesis with pleural biopsy and computerized tomography of chest, and showed ventricular diastolic restriction due to constrictive chronic pericarditis. After eight weeks of tuberculostatic treatment, the patient was submitted to hemodynamic study that confirmed the diagnosis and a pericardiectomy was performed. Long-term follow-up showed regression of diastolic restriction and decrease of hepatosplenomegaly and of jugular stasis. Tuberculostatic drugs were given for 12 months postoperatively, associated to corticosteroids.
Purulent pericarditis is an infrequent complication of infections originating in another body location. Symptoms and signs are often absent; a high index of awareness is required for its diagnosis. A patient recovering from extensive necrotic-hemorrhagic pancreatitis presented with tamponade due to methicillin-resistant Staphylococcus aureus (MRSA) purulent pericarditis, further complicated by MRSA endocarditis. Treatment included pericardectomy, IV vancomycin and teicoplanin.
Etiology of constrictive pericarditis is diversified. In recent years the role of viral and iatrogenic factors (X-ray therapy, cardiac surgery) has increased. Clinical manifestations, including subjective complaints, resemble those in congestive heart failure although the mechanism of hemodynamic disorders is different--namely impairment of ventricular filling and diastolic performance. One encounters major difficulties while differentiating constrictive pericarditis from restrictive cardiomyopathy. In some patients conservative treatment is effective, in a majority of them surgical operation, pericardiectomy is the treatment of choice.