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PubMed1996

[Results of pericardiectomy in the treatment of constrictive pericarditis].

Between 1981 and 1990 at the Cardiosurgical Clinic in Hradec Králové pericardectomy on account of chronic constrictive pericarditis was performed in 20 patients. The authors evaluated the duration of complaints, preoperative symptomatology, surgical procedure and results of the operation. Symptoms of right-sided cardiac congestion were recorded in 80% of the patients. Calcifications of the pericardium were found in 70% of the patients. During the postoperative period one patient died (5%). The long-term results evaluated at least three years after operation were very good in 65% of the operated patients. Treatment of chronic constrictive pericarditis is surgical and involves subtotal pericardectomy from medial sternotomy.

Adult↗
PubMedDate not supplied

Constrictive pericarditis after heart transplantation: report of two cases.

We report two cases of constrictive pericarditis after heart transplantation. It is noteworthy that constriction developed after a healed intrathoracic infection in the two patients. Unlike previous reported experiences, pericardiectomy was uneventful and successfully performed, although incomplete improvement was achieved in one case.

Heart Transplantation↗
PubMed1995

Atrial septal motion in effusive--constrictive pericarditis: transesophageal echocardiographic study and hemodynamic correlation.

Transesophageal echocardiography was performed in 7 patients with effusive-constrictive pericarditis to analyze atrial septal motion(ASM). In 3 patients, the ASM was found to be normal with atrial septum (AS) moving toward the right atrium from ventricular mid-systole to early-diastole and toward the left atrium from mid-diastole to early-systole. Respiration had little effect on the ASM. In 2 patients, a brisk inversion of ASM toward the left atrium at ventricular early-to-mid systole was noted during inspiration. In the other 2 patients, a sustained ASM toward the left atrium during ventricular systole was found. In 4 of these 7 patients, hemodynamic studies were performed simultaneously with the transesophageal echocardiography. The ASM reflected the pressure gradient between the left atrium (as measured by pulmonary arterial wedge pressure) and the right atrium. The augmented ASM toward the left atrium occurred as left atrial pressure decreased markedly during inspiration. In conclusion, the ASM in patients with effusive-constrictive pericarditis showed 3 patterns: normal, sustained systolic motion toward the left atrium and a brisk systolic displacement toward the left atrium during inspiration. The ASM reflects changes in the interatrial pressure gradient.

Adult↗
PubMed1996

[Pure epicarditis after surgical repair of atrial septal defect: a rare form of constrictive pericarditis. Apropos of a case].

The authors report a case of constrictive pericarditis occurring two years after surgical repair of an atrial septal defect in a 37 year-old-man. The diagnosis was made by right heart catheterisation and magnetic resonance imaging. The special feature of this clinical case was the exclusive localisation of the fibrosis on the visceral pericardium or epicarditis. The outcome was favourable after resection of the visceral pericardium respecting the parietal pericardium. Magnetic resonance imaging and right heart catheterisation performed 6 months after surgery were normal. Constrictive pericarditis is a classical complication of cardiac surgery but relatively rare after repair of an atrial septal defect. Isolated involvement of the visceral pericardium is rare and allows surgical correction by exclusive epicardectomy respecting the parietal pericardium.

Adult↗
PubMed1996

[Subacute effusive-constrictive pericarditis accompanied with miliary tuberculosis: a case report].

With the advent and the introduction of effective antimicrobial therapy, the mortality for tuberculosis pericarditis decreased in number dramatically. The problems, however, remains in several severe cases. We have experienced a rare case of 74 year old male with subacute effusive-constrictive pericarditis accompanied with miliary tuberculosis. The patient revealed improvement immediately after early an emergent pericardiectomy. However cardiac failure recurred thereafter because of fibrous epicarditis of tuberculous inflammation. Management of subacute effusive-constrictive pericarditis as this has many problems including surgical intervention such as operative timing and indication and/or role of corticosteroids together with antituberculotic drugs.

Aged↗
PubMed1996

Effusive-constrictive pericardial disease secondary to osseous metaplasia of the pericardium in a dog.

Osseous metaplasia of the pericardium causing effusive-constrictive pericardial disease has not, to our knowledge, been reported in dogs. Clinical signs of right-sided congestive heart failure prompted examination of the dog of this report. Documented causes of constrictive pericardial disease in dogs include trauma and actinomycotic, mycobacterial, and fungal infections. These causes were ruled out in this dog. Immune-mediated disorders, as have been reported in people, also were considered unlikely on the basis of test results. It was concluded that this dog had idiopathic osseous metaplasia of the pericardium and pleura. Signs of right-sided congestive heart failure resolved after subtotal pericardiectomy was performed.

Animals↗
PubMed1997

[Constrictive pericarditis complicated with hepatic coma--a case report].

A 39-year-old man with pedal edema and icterus was admitted to our hospital. Laboratory findings revealed hyperbilirubinemia. Echocardiography and chest CT revealed the calcified mass front of the right ventricle. As cardiac catheterization showed dip and plateau in right ventricle, the diagnosis of constrictive pericarditis was established. Considering his condition and bleeding tendency with hepatic failure, plasma exchange was done for three days before operation. As the patient's condition deteriorated with hepatic coma, pericardiectomy was performed. The median sternotomy approach without cardiopulmonary bypass was selected. The calcified mass was removed, and the thickened pericardium was excised. Postoperative hemodynamic findings were improved, and the serum bilirubin returned to normal. In conclusion even in this case with severe hepatic failure due to constrictive pericarditis, surgical treatment should have be considered.

Adult↗
PubMed1997

[Anesthetic managements for pericardiectomy of three patients with constrictive pericarditis].

We experienced three patients with constrictive pericarditis who underwent pericardiectomy. Percutaneous cardiopulmonary support (PCPS) was carried out in two patients because of unstable hemodynamics caused by massive bleeding or cardiac compression due to surgical manipulation. In the other patient with severe tachycardia, we prepared PCPS before the induction of anesthesia, and could manage the whole course of anesthesia satisfactorily. It is suggested that PCPS is the most reliable way to support hemodynamics during anesthesia in patients with constrictive pericarditis.

Anesthesia↗
PubMed1997

[Long-term late results of pericardiectomy for constrictive pericarditis].

Twenty-four cases of the constrictive pericarditis were operated on pericardiectomy from 1966 to 1990. One case died because of massive bleeding, LOS, and respiratory failure immediately after the operation. A long-term follow up study was performed up to 27 years (mean 13.1 years) in other cases. Ten cases died during the follow up period (cardiac: 6, non cardiac: 4). Five cases of the cardiac deaths had major complications: tabes dorsalis, chronic respiratory failure, pacemaker implantation, mitral regurgitation, emergency operation at high age (78 years old). The survival rates of 5, 10, and 15 years were 85%, 67%, and 58.2%, respectively (Kaplan-Meier). All of survival cases are now in NYHA I or II class in satisfactory. We concluded that pericardiectomy is a very effective treatment for constrictive pericarditis but a more careful follow up is required especially in cases complicated with other major problems because cardiac function is not so recovered as normal level after surgery due probably to readhesion and fibrotic changes of the myocardium.

Adult↗
PubMed1994

[Constrictive pericarditis--do we need a complete decortication?].

Pericardectomy is an established method for the treatment of various diseases, especially of constrictive pericarditis. Between 1969 and 1991, 212 cases of pericardial diseases were treated surgically. In 72 cases pericardectomy was performed for constrictive pericarditis. Surgical technique and indication for extracorporeal circulation are discussed. Postoperative haemodynamic problems were only seen in cases of preoperative advanced stage myocardial impairment. Extracorporeal circulation is only regarded as necessary in cases of strongly reduced myocardial function or if associated diseases need to be corrected.

Heart-Lung Machine↗
PubMed1997

[A case report of surgical treatment of constrictive pericarditis with coronary artery disease].

We performed the concomitant operation for constrictive pericarditis and coronary artery disease in an octogenarian. A 82-year-old male was hospitalized with dyspnea, edema of the lower extremities and pleural effusion on chest X-ray film. Cardiac catheterization revealed constrictive pericarditis and 75% stenosis of left anterior descending artery. Extensive pericardiectomy was performed including posterior wall of left ventricle and left atrium under the beating heart by using femoro-femoral partial bypass. Single CABG with a saphenous vein graft was performed following pericardiectomy. Postoperative cardiac catheterization showed good recovery of hemodynamics and patency of the bypass graft. Postoperative course was uneventful. The patient was discharged on twenty fifth postoperative day.

Aged↗
PubMed1998

[A case of constrictive pericarditis reoperated 13 years after pericardiectomy by left thoracotomy approach].

A 48-year-old male with constrictive pericarditis was reoperated through median sternotomy 13 years after pericardiectomy through left thoracotomy. Extensive pericardiectomy is the most important point for constrictive pericarditis. Therefore, we have recently chosen the median sternotomy approach which has advantages over the left thoracotomy approach. Namely, the cardiopulmonary bypass is performed in the former approach immediately if the posterior pericardiectomy is difficult or the coronary arterial injury happens during decortication.

Humans↗
PubMed1998

Rapidly evolving constrictive tuberculous pericarditis: case presentation and review of the literature.

A 69-year-old male presented with a diagnosis of idiopathic pericarditis, first treated with prednisone for a few weeks with resolution of the symptoms. A few days after stopping the medication, he presented with malaise, cough and signs of pericardial constriction confirmed by echocardiography. He was diagnosed with pulmonary tuberculosis with pericardial involvement and treated accordingly. Pericardiectomy was performed after a few days of treatment because the symptoms related to constriction progressed. The procedure was successful, and the patient was completely asymptomatic after 10 months. The removed pericardium stained positive for acid-fast bacilli.

Aged↗
PubMed1988

Paradoxic pupillary phenomena. A review of patients with pupillary constriction to darkness.

The presence of pupillary constriction to darkness is said to be a useful indicator of retinal disease. However, it is also associated with optic nerve disease. The phenomenon has been reported in patients with congenital stationary nightblindness, congenital achromatopsia, bilateral optic neuritis, and dominant optic atrophy. We have observed this response in additional disorders, including anomalies of the optic nerve development, congenital nystagmus, and a variety of diseases affecting the retina. Notably, four of our patients with strabismus and amblyopia, but without apparent retinal or optic nerve disease, have also demonstrated this paradoxic pupil response. While the mechanism for pupillary constriction to darkness remains unclear, the finding of this response in patients without retinal or optic nerve abnormalities questions its value as a localizing sign.

Child, Preschool↗
PubMed1998

Novel 31-amino-acid-length endothelins cause constriction of vascular smooth muscle.

We have reported that human chymase specifically cleaves big endothelins (ETs) at the Try31-Gly32 bond, and produces novel trachea-constricting 31-amino-acid-length ETs, ETs(1-31). In this study, we investigated the effect of synthetic ETs(1-31) on the contractile activity toward porcine coronary arteries and rat aortae. Although ETs(1-31) exhibited less potent vasoconstrictile activity in these tissues than 21-amino-acid-length ETs(1-21), or a similar extent, ET-1(1-31) caused significantly slower-developing and longer-lasting contraction than ETs(1-21). The ETA receptor antagonist, BQ485, completely inhibited the activity of ET-1(1-31). The ETB receptor antagonist, BQ788, also inhibited the activity of ET-1(1-31) toward rat aortae more efficiently than that ET-1(1-21). Therefore, trachea-constricting peptides ETs(1-31) play roles as vasoconstrictors in a different manner from ETs(1-21).

Animals↗
PubMed1996

Adrenal medullary implants reduce transsynaptic degeneration in the spinal cord of rats following chronic constriction nerve injury.

Peripheral nerve injury causes abnormal sensory processing, possibly due in part to neuroplastic changes in the CNS. Following chronic constriction injury of the sciatic nerve, transsynaptic degeneration is suggested by the presence of "dark neurons" found in superficial laminae of spinal cord. Previous studies in our laboratory have shown that grafts of adrenal medullary cells into the spinal subarachnoid space can reduce abnormal pain due to peripheral nerve injury. A possible mechanism for these beneficial effects is the reduction or interruption of excitotoxic events that lead to pathological CNS changes. In order to examine this, 2 weeks after unilateral sciatic nerve ligation using a chronic constriction injury model, animals received either adrenal medullary or control striated muscle tissue implanted in the lumbar subarachnoid space. Control striated muscle-transplanted animals with nerve injury displayed thermal hyperalgesia and elevated numbers of dark neurons in the superficial dorsal horn, compared to intact animals. These dark neurons were increased bilaterally, but predominantly ipsilaterally, to nerve injury. In contrast, in animals with adrenal medullary transplants, reduced numbers of dark neurons were found in parallel with reduced hyperalgesia. The low numbers of dark neurons in these animals were similar to age-matched unoperated controls. Two months after nerve ligation, dark neurons were not found in animals with nerve injury, although abnormal ruffled-appearing neurons were still present in untransplanted animals, suggesting partial recovery of damaged spinal neurons. The results of this study suggest that spinal adrenal medullary transplants can attenuate the neuropathological events perpetuating nerve-injury-induced pain by enhancing recovery of spinal neurons from excitotoxic insult.

Adrenal Medulla↗
PubMed1994

Increases in oxygen tension evoke arteriolar constriction by inhibiting endothelial prostaglandin synthesis.

In vivo and in vitro studies concerned with the role of oxygen in the regulation of blood flow have primarily investigated the response of blood vessels to decreases in oxygen tension. In this study, we examined the response of isolated rat cremaster skeletal muscle arterioles to increases in oxygen tensions. First-order arterioles with an average diameter of 90 microns were cannulated and pressurized to 65 mm Hg and studied under constant pressure in a no-flow state. Arterioles were equilibrated in a Krebs bicarbonate-buffered solution (ph 7.4) gassed with 21% O2, 5% CO2, 74% N2. Changes in arteriolar diameters were continuously measured and recorded in response to increases in bath PO2 (20 to 660 mm Hg). Arterioles were studied before and after either the removal of the endothelium or the administration of indomethacin (IND, 10(-5) M), to inhibit prostaglandin synthesis. When the bath PO2 was increased from 20 to 150 mm Hg, arteriolar diameters decreased by 37%; they then decreased an additional 14% when bath PO2 was increased from 150 to 660 mm Hg. Removal of the endothelium or administration of IND completely eliminated the arteriolar constrictions in response to increases in PO2 from 20 to 150 mm Hg, and from 150 to 660 mm Hg. These observations suggest that rat cremaster arterioles constrict to increases in oxygen tension by reduction in the synthesis of endothelium-derived dilator prostaglandins.

Animals↗
PubMed1980

Electron microscopic study of the early changes proximal to a constriction in myelinated nerve.

An ultrastructural study has been carried out of the changes observed proximal to a nerve constriction in rabbits. The lesion was experimentally produced with a silk ligature. Specimens were examined 24 h after ligation. Significant alterations of the ultra structure were found in sections taken at approximately 1 mm above the constriction. Examination revealed swelling of the nerve fibres due to failure of axoplasmic flow, a marked increase in the number of mitochondria, most of which showed degenerative changes and degenerative changes in the myelin sheath.

Animals↗