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Delayed hemopericardium with constrictive pericarditis after blunt trauma: a report of a surgical case.

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.

Adult↗

[Experience with the surgical management of constrictive pericarditis].

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.

Adolescent↗

[Constrictive pericarditis as differential diagnosis of hepatic disease].

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.

Adolescent↗

[Constrictive pericarditis].

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.

Adolescent↗

[Effects on hemodynamics and myocardial metabolism of prostaglandin E1 and trimethaphan after a descending aorta cross-clamp in experimentally coronary constricted dogs].

We investigated the hemodynamic effects of prostaglandin E1 (PGE1) and trimethaphan (TMP) during cross-clamp of the descending aorta in experimentally coronary constricted dogs. Using 21 mongrel dogs, the blood flow of the left anterior descending coronary artery was reduced to 50% by constricting the artery. After stabilization of hemodynamics, we cross-clamped descending aorta and administered PGE1 (1.0 microgram.kg-1.min-1) or TMP (5.0 micrograms.kg-1.min-1). The drugs were discontinued just before the clamp on the aorta was released. In the PGE1 group, cardiac output (CO) and left ventricular dp/dt (LVdp/dt) increased significantly 5 minutes after clamping, with CO remaining at its high level even after the clamp was released. In the TMP group, CO increased significantly 15 minutes after administration and returned to the preclamping value soon after declamping. LVdp/dt was unchanged during clamping and decreased significantly after declamping. In addition, marked increase of the myocardial blood flow (MBF) in the ischemic areas was seen in the PGE1 group, whereas no changes were seen with the TMP. In the ischemic heart, PGE1 can not only decrease afterload which is elevated by the cross-clamping of the aorta, but also increase the coronary blood flow and MBF in the ischemic areas.

Alprostadil↗

Congenital constriction band associated with pseudarthrosis and impending gangrene. A case report.

A newborn baby with a severe congenital constriction band associated with pseudarthrosis and impending gangrene of the foot is described. Early one-stage circumferential excision of the band with immediate wound closure by multiple Z-plasties salvaged the compromised foot. The pseudarthrosis indicated the severely compressive nature of the fibrous band. The uneventful healing of the pseudarthrosis and the full recovery of neurovascular function points to essential normal tissue underlying the constricting band.

Constriction, Pathologic↗

[Surgical treatment of constrictive pericarditis].

Since 1957, 30 patients with constrictive pericarditis have been treated surgically in Kyushu University Hospital. The surgical approaches were the left anterolateral thoracotomy in 17 patients (group I); the median sternotomy without cardiopulmonary bypass (CPB) in 6 patients (group II); and the median sternotomy with CPB in 7 patients (group III). The hospital mortality was 3.3 percent. The mean postoperative follow-up period was 11.7 years (longest 30 years). The actuarial survival rate at 5 years postoperatively was 88% in total cases (100% in group I, 82% in group II and 52% in group III), 88% at 10 years, 75% at 15 years and 67% at 20 years. Several patients in group III, who underwent complete pericardiectomy using CPB showed severe congestive heart failure and arrhythmia postoperatively. The comparative study between an poor result group (patients who died within 10 years post-operatively) and a good result group (patients who survived more than 10 years postoperatively revealed that preoperative hepatomegaly, atrial fibrillation and the interval between the onset of symptoms and the pericardiectomy influenced the survival rate significantly. These results suggested that pericardiectomy using CPB was a safe method for removing the calcified pericardium in the patient with severe constrictive pericarditis. However, a careful long term follow-up was necessary for the patient with severe myocardial damage even though the complete pericardiectomy was performed.

Adolescent↗

[Chronic constrictive pericarditis complicating an apparently stable rheumatoid arthritis. Report of a new case (author's transl)].

The authors report a case of constrictive pericarditis complicating an apparently stable sero-negative rhumatoïd arthritis, a rarely described pathological association. The patient had a serious polyserositis due to an extremely marked and inflammatory pericardial constriction. The rhumatoïd origin was confirmed by pericardial effusion, histological and immunofluorescent studies. The inflammatory pericardial process rendered pericardiectomy virtually impossible and resulted in a fatal outcome.

Adult↗

[The degree of functional circulatory failure according to NYHA classification and the state of hemodynamic disorders in constrictive pericarditis].

Selected indices of left and right ventricular function and pulmonary circulation have been compared in two groups of patients with constrictive pericarditis: i.e. in 10 patients classified as NYHA functional class II and 13 patients as NYHA class III. The patients with NYHA class III showed higher average values of left ventricular end-diastolic pressure (mean + 19.4 vs 11.4 mm Hg) and right ventricular end-diastolic pressure (mean + 17.3 vs 9.5 mm Hg) as well as pulmonary systolic (mean + 39.5 vs 24.5 mm Hg) and diastolic pressure (mean + 20.6 vs 9.9 mm Hg). Mean total pulmonary resistance and left and right ventricular stiffness indices were slightly higher whereas cardiac index was slightly lower. Complaints of patients with constrictive pericarditis, fatigability and dyspnea are to a large extent determined by the level of end-diastolic pressure in both ventricles and pulmonary hypertension that is by similar direct mechanism as in congestive heart failure.

Adolescent↗

[Pulmonary circulation in constrictive pericarditis].

Certain indices of pulmonary haemodynamics were determined at rest in 39 patients with constrictive pericarditis. The most frequent anomaly was raised value of total pulmonary resistance (in 82% of cases) and, in a lower percent, raised pulmonary vascular resistance. The systolic pressure in the pulmonary artery was raised in 30.8% of the patients, reaching values regarded as low or medium degree hypertension. In only 2 cases the systolic pressure in the pulmonary artery was 100 mm Hg or more. The systolic pressure in the pulmonary artery showed a slight positive correlation with the end-diastolic pressure in the left ventricle, and the subgroup with pulmonary hypertension had higher average values of the end-diastolic pressure in the left ventricle than patients with normal pressure in the pulmonary circulation (means = 21.0 +/- 5.7 vs 15.2 +/- 6.5 mm Hg). These results show a significant role of increased filling pressure of the left ventricle in the mechanism of pulmonary hypertension in patients with constrictive pericarditis.

Adolescent↗

[Experimental evaluation for tricuspid annular constriction with the model of tricuspid annular dilatation].

We have obtained the good result about tricuspid annular constriction (TAC) for secondary tricuspid insufficiency. The purpose of this study is to investigate the effectiveness of TAC for the experimental model of tricuspid annular dilatation. First of all, tricuspid annular dilatation was made surgically in 8 mongrel dogs by placing 8 incisions to tricuspid annulus except septal cusp under the condition of heart-lung preparation. On clinical evaluation, septal annulus was kept to be intact in many cases compared with the two other areas. This experimental model of tricuspid annular dilatation was considered to be substituted to the clinical model of tricuspid annular dilatation. TAC suture was surrounded circumferentially around the dilated tricuspid annulus. And then, TAC suture was pulled out from the right atrial wall, and the circumferential length of tricuspid annulus was completely accommodated by pulling the TAC suture. The hemodynamic status was observed by right atrial pressure (V wave and mean) and right ventricular end-diastolic pressure (RVEDP). After heart resuscitation and gradual increase of preload, right atrial pressure was significantly elevated especially right atrial pressure (V wave) compared with control values. When 2 cm of circumferential length of tricuspid annulus on an average was constricted by shortening of TAC suture, right atrial pressure was significantly decreased, and then RVEDP tended to decrease. It was shown that TAC was an effective operative technique for the secondary tricuspid annular dilatation and tricuspid insufficiency from the standpoint of experimental aspect as well as clinical results.

Animals↗

[A case of rapidly developed constrictive pericarditis following acute non-specific pericarditis].

A case of constrictive pericarditis which developed within one month after the onset of acute pericarditis was presented. A 3-year-old boy was admitted to our hospital suffering from dyspnea. Pericardectomy was performed 3 weeks after the pericardial drainage. His echocardiograms revealed the progressive thickening of the pericardium, severely restricted ventricular motion in both systole and diastole and paradoxical motion of the interventricular septum. Echocardiography at close intervals is useful for making the diagnosis and decision of the surgical intervention of rapidly developed constrictive pericarditis.

Acute Disease↗

[A case of effusive-constrictive epicarditis found by electrocardiogram at a school health examination].

An effusive-constrictive pericarditis confined to the epicardium is extremely rare in childhood. We report case of a 7-year-old boy with such a condition. During an annual school health examination, he was found to have low voltage activities on electrocardiogram. On admission, physical examination showed markedly distended abdomen due to ascites and hepatomegaly. Two-dimensional echocardiography revealed small ventricular cavities, extremely dilated inferior vena-cava, and a moderate amount of pericardial fluids. Pericardial and epicardial thickening were also suspected. Retrospectively, epicardial thickening was suspected on computed tomogram as well. Cardiac catheterization showed a typical diastolic dip and plateau pattern on the right ventricular pressure tracing, and deep x and y descents on that of the right atrium, suggesting that not pericardial effusion, but pericardial thickening mainly contributed to the cardiac dysfunction. Pericardiocentesis did not improve the clinical symptoms and high central venous pressure. On thoracotomy, we unexpectedly found intact pericardium and fibrotic epicardium covering the whole heart, so epicardiectomy was performed. Despite the fact that most of the fibrotic epicardium was removed, there were no immediate responses such as decrease in central venous pressure within the first 5 days after the surgery. Furthermore, it was not until two months later that all symptoms and hemodynamic parameters returned to normal levels. There have been several case reports of isolated epicardial constriction associated with pericardial effusion in English literature. However, we are unaware of such a report n Japanese. We concluded that it is important to evaluate the hemodynamics before and after pericardiocentesis, and to detect peri-and/or epicardial thickening by serial echocardiography and CT scan.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

Pericarditis, pericardial effusion, cardiac tamponade, and constriction.

Critical care aspects of pericardial disease are covered, including diagnosis and differential diagnosis of acute pericarditis, pericardial effusion with and without cardiac tamponade, constrictive pericarditis and effusive-constrictive pericarditis. Emphasis is placed on clinical signs and the important invasive and noninvasive diagnostic procedures, particularly various imaging methods (emphasis on echocardiography), electrocardiography, and cardiac catheterization. Medical and surgical therapies are reviewed, and the technique of pericardiocentesis is presented.

Cardiac Tamponade↗

Surgical treatment for chronic constrictive pericarditis.

One hundred and twelve patients were operated for constrictive pericarditis from December 1963 through May 1987 at J.J. Group of Hospitals, Bombay. All the patients had haemodynamically significant pericardial constriction preoperatively, and pericardial disease was confirmed at operation. Preoperatively, the patients were either in NYHA class III (96 cases), or class IV (16 cases). All the patients had ascites and/or peripheral oedema with an enlarged liver. Pericardiectomy was performed through a left anterior thoracotomy (92 cases), or median sternotomy (20 cases). There was an early mortality (deaths occurring within 30 days of operation) in 21 cases (18.75%). Early mortality was related to preoperative disability of the patients. Post-operatively, NYHA classification of patients at six months after operation showed improvement in functional class with 80 patients in either class I or II and 6 patients in class III.

Adolescent↗

[Postoperative constrictive pericarditis].

Seven cases of postoperative constrictive pericarditis (PCP) were discovered in a retrospective study of patients given heart surgery in a hospital receiving patients from all over Italy in 1970-85. Five of those patients had received surgery for chronic rheumatic heart disease, 2 for congenital heart defects. Four had received a second heart operation before the pericardial condition was recognised. All were females and all presented systemic venous hypertension (one of them only after acute doses of physiological solution) with thickening of the pericardial layers revealed by sonography. In six cases the electrocardiographic ventricular complexes were normal or increased in amplitude and the heart/chest ratio was greater than 0.55. Pericardial knock was masked by natural or artificial atrioventricular valve opening noises in 6 cases. In one case only there were pericardial calcifications or signs of an earlier postpericardiotomy syndrome. The haemodynamic investigation revealed signs of ventricular diastolic constriction in 6 patients. Three patients died from complications of cardiac cirrhosis: 2 of them had previously received partial pericardiectomy. Another two, given the same operation, preserved a reasonable functional capacity 5 and 10 years after the pericardiectomy. One patient in NYHA functional class III has so far refused haemodynamic assessment (and surgical treatment) of the pericardial disease. Finally, the last patient complains only of attacks of heart palpitation caused by atrial flutter and controlled by antiarrhythmic treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Antimyosin antibodies and constrictive pericarditis in lupus erythematosus.

We report the first case of constrictive pericarditis in a woman with systemic lupus erythematosus (SLE). Immunopathologic studies demonstrated IgG, IgA, IgM and C3 distributed throughout her pericardium including vessel walls. Cardiospecific antimyosin, antisarcolemmal and antipericardial antibodies were detected in serum obtained prior to surgery or steroid therapy. Antibodies disappeared and creatine phosphokinase decreased to normal concentrations during prednisone therapy. Antimyosin antibodies were not detected in 11 sera or in one pericardial fluid obtained from patients with lupus with active pericarditis unaccompanied by constriction. Evaluation of antimyosin antibodies in other patients with this rare manifestation of SLE is warranted to further assess their pathologic significance.

Adult↗