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Constrictive pericarditis is a rare but potentially life-threatening complication of pregnancy. This is a case report of irradiation-induced constrictive pericarditis requiring pericardiectomy during pregnancy. It is hoped that our team approach to this particular problem can serve as a model for the management of similar medical and surgical complications of pregnancy.
Isolated lung parenchymal strips (peripheral airways) of cats responded to histamine, carbachol, 5-HT, bradykinin and honey bee-venom with concentration-dependent contractions. Atropine, mepyramine and methysergide inhibited or reversed contractions to carbachol, histamine and 5-HT respectively. Atropine, methysergide and indomethacin did not influence contractions to honey bee venom. High doses of mepyramine (H1-antagonist) inhibited or reversed the bee venom-induced contractions. These observations suggest that honey bee venom may be constricting cat peripheral airways by releasing endogenous histamine from the lung mast cells. Aceylcholine, 5-HY and prostaglandins appear to play little or no important role in the peripheral airway constrictions to honey bee venom in cat.
Constrictive pericarditis is a common complication of purulent pericarditis and it can evolve to hemodynamic patterns different from the classical one. We report a patient that after purulent pericarditis, his clinical and hemodynamic features suggest isolated constriction of the left ventricle.
Constriction of the umbilical cord by an amniotic band is a rare entity, associated with a high rate of fetal mortality and congenital anomalies. A case occurred with early detection and successful intervention for fetal compromise caused by the amniotic band, which was associated with first-trimester amniocentesis. This is the first known report of ultrasound Doppler flow studies in a case of umbilical cord constriction by an amniotic band, showing reverse diastolic flow in the umbilical arteries.
A 34-year-old female with rhythm disturbance and characteristic hemodynamic features of constrictive pericarditis is presented. A left ventricular wall open needle biopsy revealed mild mononuclear cell infiltration suggestive of myocarditis. The patient died of intractable heart failure seven years later. The autopsy revealed left and right ventricular dilatation, multiple foci of mononuclear cell infiltration, and diffuse replacement fibrosis in 31%, 13% and 14% of the areas of the left ventricular free wall, ventricular septum, and right ventricular wall, respectively, predominantly in the inner layers (68%). The pericardium was intact. These clinically constrictive pericarditis-like findings are considered to be secondary to chronic active myocarditis.
Constriction of the femoral vein is a well known complication to the Cooper ligament repair of inguinal hernia. This may occur as the transversalis fascia and aponeurosis are sutured to Copper's ligament, either because a suture is passed through the vein or the vein is compressed by tissue. Clinical presentation is usually signs of deep venous thrombosis or pulmonary embolism. Venography verifies the diagnosis by showing a characteristic constriction of the femoral vein.
The heart has an endocrine activity which depends on the secretion of a natriuretic, diuretic and hypotensive factor contained in osmophilic, secretory granules localized in the myocardiocytes and called "atrial specific granules" (the atrial natriuretic factor, ANF). In this paper, the relationship between these specific granules and renovascular hypertension elicited by the constriction of both renal arteries was investigated at the electron microscope level during the acute, subacute and chronic phases of hypertension. Male Wistar CHbb THOM rats were divided in three groups: 1) clipped rats; 2) sham operated rats; 3) ether anesthesia as unique manoeuver 48 h before decapitation. Blood pressure increased progressively after the constriction of both renal arteries. The atrial specific granules were not affected by ether anesthesia alone; 48-72 h after clipping the granules almost disappeared and this situation persisted up to the 6th week. In sham operated rats the picture was very similar to the clip rats 48 and 72 h after surgery (severe granule disappearance); in contrast, at one, two and six weeks after surgery, the granularity of cardiomyocytes in sham rats was absolutely restored. It is concluded that: 1) similarities in morphology of atrial specific granules in sham and clip rats 48 and 72 h after surgery would suggest that stress plays a primary role in determining the observed images; 2) thereafter, the contrast between sham and clip rats 1, 2 and 6 weeks after surgery would indicate that the ANF is linked to the subacute and chronic regulation of renovascular hypertension.
In relation with one case of constrictive pericarditis folowing myocardial infarction, the respective part played by the Dressler syndrome and by the anticoagulant treatment in the genesis of pericardial constriction was discussed. In presence of an inflammatory pericardial reaction after myocardial infarction, the rules for the use of anticoagulants are discusses.
In suggestive clinical presentations, the diagnosis of constrictive pericarditis is confirmed by the haemodynamic findings of impaired ventricular filling (diastole). In this study of 15 patients with pure constrictive pericarditis, the diagnosis value of two non-invasive techniques little used in this indication until now was examined: radionuclide ventriculography (RV) and magnetic resonance imaging (MRI). The RV provides a "functional" diagnosis through the analysis of global and segmental left ventricular filling whilst MRI provides anatomical details of the pericardial thickening. Diastolic dysfunction on RV presented as an increased early diastolic filling time as shown by a shortening of the interval to third filling T1/3R (p < 0.0001), an increased peak diastolic E wave velocity (p < 0.01) and early onset (p < 0.001), increased one third (FR 1/3) and mid (FR 1/2) diastolic filling fractions (p < 0.01) and of the E wave velocity to maximal systolic ejection velocity (S) ration (p < 0.01). The atrial contribution to filling in end diastole decreased (NS). Asynchronous filling, shown by dispersion of the times of onset of segmental early diastolic E peak velocities (delta tE) or of one third diastolic filling delta T1/3R, decreased. Seven patients underwent MRI. Pericardial thickening was present in all patients. The pericardium varied from 6 to 14 mm thick (normal 2.5 +/- 0.7 mm), without any systolo-diastolic variation. The thickening was seen as a dark low intensity signal, indicating the fibro-calcific character of the tissues. Sagittal and coronal views clearly demonstrated the non-uniformity of pericardial thickening.(ABSTRACT TRUNCATED AT 250 WORDS)
Penile strangulation caused by a thread or human hair is an uncommon cause of urethral injury described in paediatric practice. Five children presented with this entity to the Aga Khan University Hospital, Karachi between August, 1991 and August, 1992. Three children had uneventful recoveries after removal of the constricting agent. Two patients developed urethrocutaneous fistulae and partial amputation of the penis because of late presentation. Early recognition and removal of the constricting agent is necessary to prevent serious complications.
We reported a 51-yr-old female with radiation-induced chronic constrictive pericarditis. At age 29, she had received a mastectomy and postoperative irradiation because of left breast cancer. At age 45, she had syncope and was diagnosed with complete atrioventricular block and a pacemaker was implanted. At that time, pericardial thickening with effusion was noted. The following year, tricuspid regurgitation was noted. On catheter study, a dip and plateau pattern of the right ventricular pressure curve appeared. At age 50, tricuspid regurgitation worsened due to the lead wire of the pacemaker compressing the leaflet, and the pacemaker was reimplanted. However, the following year, she complained of general fatigue and dyspnea and was admitted to our hospital. On 67Ga study, diffuse accumulation in the cardiac region appeared. There was no perfusion defect detected in the left myocardium, but right myocardial damage was suspected by thallium study. In 99mTc-HSA RI angiography, right atrium dilatation appeared and a pericardial halo around the ventricles was seen. She underwent pericardectomy, tricuspid replacement and pacemaker reimplanted, but she died. On autopsy, pericardial thickening and adhesion, right myocardial fibrosis, the fibrotic change of the bundle branches were seen. We reported a case of radiation-induced constrictive pericarditis. Radionuclide studies were useful in diagnosing and following the patient.
A case of a 53-year old man is presented who developed postpericardiotomy syndrome and subsequently constrictive pericarditis following prosthetic aortic valve replacement due to severe aortic stenosis. The diagnosis was based on clinical picture and confirmed invasively. Nearly total excision of thickened fibrous pericardium resulted in a slow but full disappearance of constriction signs.
Electron microscopic study of the small intestine in cases of intestinal lymphangiectasia and in cases of constrictive pericarditis was performed. This study revealed that numerous chylomicron-like particles are present in the lymphatic lumina, in the extracellular spaces of the lamina propria, and within the interepithelial spaces between the absorptive cells. Presence of chylomicron-like particles in the intestinal lumen suggested possibility of passage of these substances into the intestinal tract through the interepithelial spaces. Similar findings to those as seen in intestinal lymphangiectasia were observed in constrictive pericarditis. A few pseudopode-like cytoplasmic projections of the undifferentiated crypt cells were noted. Other mechanisms of enteric protein loss are postulated.
A case of constrictive pericarditis that occurred 4 months after CABG is reported. After undergoing CABG the patient developed pneumopericardium with a subsequent pericardial effusion, which were successfully treated with steroids and diuretics and the patient was discharged asymptomatic. About 3 months later easy fatiguability, abdominal bloating and pedal edema appeared, prompting him to undergo a thorough examination, which revealed the presence of constrictive pericarditis. At that time the graft was shown to remain patent. Eight months post CABG pericardial stripping was performed through a median sternotomy with confirmation of a fall in the CVP and PAP (diastolic) intraoperatively. Towards postoperative day 3, however, the CVP rose again with reappearance of abdominal bloating. Hence, cardiac catheterization was performed once again. The RV pressure tracing showed dip and plateau, and reoperation was performed. Pericardial stripping performed on the lateral and supradiaphragmatic sides of the left ventricle via a left anterior thoracotomy brought about a satisfactory hemodynamic improvement.
A case of pericarditis in a 52-year old patient following aorto-coronary shunt surgery is reported which gradually developed into chronic constrictive pericarditis. In this context, the diagnostic criteria of chronic constrictive pericarditis are recalled. The clinical criteria show little specificity; Doppler ultrasound provides good diagnostic information; CT scans and nuclear magnetic imaging can confirm the diagnostic. The post-heart surgery etiology has increased in recent years. The only real treatment is surgical and consists of pericardial decortication.
The authors present the clinical history of a male 44 year old patient who was hospitalized with the diagnosis of pericardial constriction and effusion and operated on as an emergency because of spontaneous cardiac rupture and was found to have a cardiac adenosarcoma. They review the literature in order to discuss a very rare cause of hemopericardium and constrictive pericarditis with epidemiologic, diagnostic, therapeutic and prognostic commentaries and secondly, to try to establish if this type case does not represent a diagnostic problem for the ecocardiographer since an angiosarcoma that occupies the pericardial space can be confused with a hemopericardium. They also mention other imaging studies that are used to better characterize and diagnose these tumors.
The most appropriate operation for constricting pericardial disease must be selected to provide optimum chance for permanent recovery of myocardial function with minimal morbidity. Our 18 patients demonstrate the changing cause of pericardial constrictive disease and the application of newer surgical treatments. Good results were obtained in 16 patients.
We experienced a case of constrictive pericarditis with dissecting aortic aneurysm (DeBakey type II). The patient complained of orthopnea and leg edema. The cause of constrictive pericarditis was pericardial effusion due to dissecting aortic aneurysm. Ascending aortic replacement with graft and decortication of thickened pericardium were performed. We confirmed the decrease of CVP and PAP intraoperatively. Postoperative course was uneventful.