Treatment of Massive Fluid Overload as a Result of Constrictive Pericarditis With Ultrafiltration in the Emergency Department

We present a case of massive fluid overload as a result of chronic lupus-related constrictive pericarditis, which was treated in the emergency department (ED) with ultrafiltration. With this novel technique, a large volume (7,350 mL) was extracted during 19 hours, with dramatic clinical improvement. The patient was hemodynamically stable throughout the intervention, and the procedure was tolerated without complication. This report highlights the challenges associated with the treatment of such individuals and the potential benefits of ultrafiltration in the ED setting.

A rare cause of constrictive pericarditis: Primary cardiac lymphoma

We described a patient who presented with symptoms of heart failure and was found to have diastolic heart failure. Several investigations pointed to the diagnosis of constrictive pericarditis which was later confirmed by cardiac catheterisation. The etiology turns out to be primary cardiac lymphoma which is extremely rare in immunocompetent patients. This is followed by a brief review on the clinical presentation, diagnostic approach and management of primary cardiac lymphoma.

[The Waffle procedure for constrictive epicarditis after direct closure of atrial septal defect; report of a case]

A 20-year-old man was admitted with a diagnosis of constrictive pericarditis 6 months after direct closure of atrial septal defect (ASD). He complained of fatigue and dyspnea. Cardiac echo cardiography, computed tomography (CT), magnetic resonance imaging (MRI) and cardiac catheterization suggested pericardial and epicardial constriction. During the operation, the thickened pericardium was peeled off. Multiple longitudinal and transverse incisions were made in the thickened epicardium as reported by waffle. Postoperative hemodynamic state was improved. The cardiac index increased from 1.91 to 3.17 l/min/m2. The pulmonary capillary wedge pressure (PCWP) decreased from 26 to 14 mmHg, although dip and plateau pattern was maintained. The postoperative course was uneventful.

Investigation on Colchicine for Acute Pericarditis: a multicenter randomized placebo-controlled trial evaluating the clinical benefits of colchicine as adjunct to conventional therapy in the treatment and prevention of pericarditis; study design amd rationale

BACKGROUND

Colchicine is safe and effective in the treatment and prevention of recurrent pericarditis after failure of conventional treatment. The recent guidelines of the European Society of Cardiology suggest that colchicine might be useful even in the treatment of the first episode. However, the use of the drug is not based on any strong evidence obtained from clinical trials, and no randomized placebo-controlled trial is available to guide the management of acute pericarditis.

STUDY DESIGN

The Investigation on Colchicine for Acute Pericarditis (ICAP) trial will enroll 240 patients in a prospective, randomized, double-blind, multicenter investigation of colchicine compared to placebo in patients with acute pericarditis. The primary efficacy end point is the recurrence rate at 18 months. The secondary end points are symptom persistence at 72 h, remission rate at 1 week, number of recurrences, time to first recurrence, disease-related hospitalization, cardiac tamponade, and constrictive pericarditis.

IMPLICATIONS

The ICAP trial will be the first randomized placebo-controlled trial in this area. This trial will provide important evidence regarding the possible benefit of the early use of colchicine in the treatment of acute pericarditis and the primary prevention of recurrences, the most troublesome and commonest complication of pericarditis.

Prognosis of idiopathic recurrent pericarditis as determined from previously published reports

After a systematic review of all publications on recurrent pericarditis from 1966 to 2006, we identified 8 major clinical series including a total of 230 patients with idiopathic recurrent pericarditis (mean age 46 years, men/women ratio: 0.9). After a mean follow-up of 61 months, the complication rate was 3.5% cardiac tamponade and 0% constrictive pericarditis and left ventricular dysfunction. The overall life prognosis is excellent in idiopathic recurrent pericarditis and complications are uncommon. In conclusion constrictive pericarditis was never reported despite numerous recurrences, and the risk is lower than in idiopathic acute pericarditis (approximately 1%). Thus, it is important to reassure patients on their prognosis, explaining the nature of the disease, and the likely course. Therapeutic choices should take into account of the overall good outcome of these patients, including less toxic agents.

Spontaneous aortic arch rupture with pseudoaneurysm and constrictive-effusive pericarditis formation

Spontaneous aortic rupture, without any history of previous thoracic trauma, infection or acute thoracic pain is an extremely rare and potentially life-threatening event. Its diagnosis, in the absence of acute symptoms, is usually delayed and relies on secondary signs. While the etiology is atherosclerotic in most cases, the exact mechanisms of rupture have only recently been uncovered. Treatment may be surgical, endovascular or by a combined procedure, according to the anatomy, location and expertise of the medical team.

[Surgical treatment of chronic constrictive pericarditis due to old tuberculosis; report of a case]

We experienced a case of pericardiectomy to treat constrictive pericarditis due to old tuberculosis. A 40-year-old woman was admitted to our hospital with dyspnea on exertion and edema of both legs. The chest computed tomography showed calcification of anterior ventricles. They were tightened up by calcified band. Subtotal pericardiectomy and removal of the calcification were performed without cardiopulmonary bypass. After the operation, symptoms were not disappeared in early phase. However, improvement for the patient was confirmed 3 months later.

Constrictive Pericarditis After Left Extrapleural Pneumonectomy and Radiotherapy for Malignant Mesothelioma

We report the devastating complication of constrictive pericarditis after multimodality therapy including left extrapleural pneumonectomy for malignant pleural mesothelioma. The patient presented with progressive dyspnea, ascites, and peripheral edema 6 months after receiving adjuvant radiotherapy. A diagnosis of constrictive pericarditis was made late in the clinical course after exhaustive investigation to exclude primary disease recurrence. Pericardial decortication was subsequently undertaken 12 months after the initial surgery, but the patient died of multi-organ failure. Our experience, combined with a review of the available literature, leads us to advise a low level of suspicion and early operation to relieve cardiac constriction. Furthermore, these complications emphasize the importance of trials such as the Mesothelioma and Radical Surgery (MARS) study.

Idiopathic chronic constrictive pericarditis secondary to calcified pericardial haematoma

Pericardial haematoma is a rare entity that is thought to arise acutely as a consequence of blunt chest wall injury. We report our experience with a chronic form of presentation in which calcified pericardial haematoma presented as a mass causing chronic constrictive pericarditis symptoms in a patient with no prior history of chest wall injury. The ability to recognize such a rare occurrence is vital as surgery will often be curative.

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.

Constrictive pericarditis of tuberculous etiology in the HIV-positive patient: case report and review of the literature

Pericardial inflammation secondary to Mycobacterium tuberculosis infection is a rare condition, but its incidence is increasing in parallel with human immunodeficiency virus infection. Recrudescence of various types of tuberculosis should alert the clinician to the possibility of tuberculous pericarditis. The authors present the case of a 27-year-old white male, seropositive for the human immunodeficiency virus, presenting with large volume pericardial effusion and unusual echocardiographic features, global heart failure and clinical suspicion of tuberculosis. After anti-tuberculous chemotherapy and systemic corticosteroids there was some clinical improvement but evolution to constriction. The patient underwent pericardiectomy with good results. The authors present a literature review on constrictive tuberculous pericarditis in human immunodeficiency virus seropositive and seronegative patients, discussing the role of corticosteroids and the contribution of different diagnostic tools.

Metastatic signet ring adenocarcinoma: an unusual cause of cardiac constriction

Pericardial constriction secondary to metastatic adenocarcinoma is exceedingly rare. We present the first recorded case of pericardial constriction secondary to metastatic signet-ring mucinous adenocarcinoma diagnosed by echocardiography. The cornerstones of echocardiographic diagnosis of constriction are the following: interventricular septal bounce phasic with respiration, M-mode recordings of the inferior vena cava, and the characteristic Doppler velocity patterns recorded from the mitral valve, hepatic veins, and mitral annulus.

[Long term evolution of chronic constrictive pericarditis. A study of 56 patients]

OBJECTIVE AND METHOD

We retrospectively analysed 56 consecutive patients with a confirmed diagnosis of chronic constrictive pericarditis over a period of 23 years. The objective was to analyse the evolution of the annual frequency of constrictive pericarditis, its aetiology and to define the prognostic factors for mortality.

RESULTS

The annual frequency of constrictive pericarditis has not diminished over the 23 years of this study, remaining at 2.4 cases per year. Cases with a tuberculous origin have diminished progressively, being replaced by complications of cardiac surgery and mediastinal radiotherapy. Pericardectomy was performed in 41 patients and the average follow up was 9.5 +/- 8.6 years. By the end of the study, 34 patients had died (61.8%), 18 from a cardiovascular cause (38.3%). The independent predictive factors for overall mortality were a history of mediastinal radiotherapy, the age, and plasma sodium level. Only the presence of first degree atrio-ventricular block was an independent predictive factor for cardiovascular mortality. In the pericardectomy group, 24 patients died (60%). A history of mediastinal radiotherapy and the presence of pre-operative hyponatraemia were independent predictive factors for overall mortality.

CONCLUSION

Constrictive pericarditis remains a serious pathology. Pericardectomy allows a clear functional improvement, but following pericardectomy more than 60% of patients will die within 10 years of the diagnosis being made.

Chronic Expanding Intrapericardial Hematoma After Pericardial Paracentesis

Chronic expanding intrapericardial hematoma (CEIH) is rare. A thorough search of literature revealed a few cases after open heart surgery, chest trauma, or epicardial injury. We report the case of a 72-year-old man presenting with a large CEIH and constrictive pericarditis, who had no past history of the above conditions but had undergone pericardiocentesis four years earlier. The cause of the initial hemorrhage of the hematoma might be due to a scratch by a needle during pericardial paracentesis. The hematoma had expanded during a course of four years. The hematoma was removed surgically, and there has been no sign of recurrence 17 months after the operation.

Three-Vessel Coronary Artery Disease, Aortic Stenosis, and Constrictive Pericarditis 27 Years after Chest Radiation Therapy: A Case Report

A patient with a history of Hodgkin's lymphoma presented with recurrent left pleural effusions and dyspnea on exertion 27 years after radiation therapy. Further evaluation disclosed suspected radiation-induced constrictive pericarditis, aortic stenosis and regurgitation, and severe coronary artery disease. He underwent successful 3-vessel coronary artery bypass grafting, aortic valve replacement, and pericardiectomy.