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Al-Kazaz M, Klein AL, Oh JK, Crestanello JA, Cremer PC, Tong MZ, Koprivanac M, Fuster V, El-Hamamsy I, Adams DH, Johnston DR. Pericardial Diseases and Best Practices for Pericardiectomy: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 84:561-580. [PMID: 39084831 DOI: 10.1016/j.jacc.2024.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/09/2024] [Accepted: 05/01/2024] [Indexed: 08/02/2024]
Abstract
Remarkable advances have occurred in the understanding of the pathophysiology of pericardial diseases and the role of multimodality imaging in this field. Medical therapy and surgical options for pericardial diseases have also evolved substantially. Pericardiectomy is indicated for chronic or irreversible constrictive pericarditis, refractory recurrent pericarditis despite optimal medical therapy, or partial agenesis of the pericardium with a complication (eg, herniation). A multidisciplinary evaluation before pericardiectomy is essential for optimal patient outcomes. Overall, given the good outcomes reported, radical pericardiectomy on cardiopulmonary bypass, if feasible, is the preferred approach. Due to patient complexity, as well as the technical aspects of the surgery, pericardiectomy should be performed at high-volume centers that have the required expertise. The current review highlights the essential features of this multidisciplinary approach from diagnosis to recovery in patients undergoing pericardiectomy.
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Affiliation(s)
- Mohamed Al-Kazaz
- Bluhm Cardiovascular Institute, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan A Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul C Cremer
- Bluhm Cardiovascular Institute, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Bluhm Cardiovascular Institute, Division of Cardiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Z Tong
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marijan Koprivanac
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Valentin Fuster
- The Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ismail El-Hamamsy
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David H Adams
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Douglas R Johnston
- Bluhm Cardiovascular Institute, Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Santaularia-Tomas M, Sanchez-Felix E, Santos-Zaldivar K, Grosjean-Alvarez A, Mendez-Dominguez N. Pericardial Calcification: An Uncommon Case with Intraventricular Extension. Tomography 2024; 10:1024-1030. [PMID: 39058048 PMCID: PMC11281272 DOI: 10.3390/tomography10070076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/19/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
An 80-year-old man presented to the cardiology outpatient clinic due to shortness of breath. His past medical history included alcohol intake, hypertension, inferior wall myocardial infarction (five years ago), an ischemic stroke, and permanent atrial fibrillation (diagnosed three years before the current examination). A physical exam revealed a decreased intensity of S1 and S2, irregular rate and rhythm, and no murmurs nor friction rub. X-rays, Computed Tomography, and echocardiography exhibited pericardial calcification, involving mostly the inferior wall and protruding into the left ventricle. A diagnosis of constrictive pericarditis due to pericardial calcification was established and considered idiopathic. Even when it may be related to ischemic heart disease, post-infarction pericarditis could explain how the calcification extended to adjacent territory perfused by the circumflex coronary artery. Combined imaging studies were crucial not only for identifying calcium deposits in the pericardium but also in assessing a patient inherently prone to co-existing and exacerbating conditions. Even though pericardiectomy allows for removal of the clinical manifestations of congestive pericarditis in the most symptomatic patients with pericardial calcification, among patients like ours, with tolerable symptoms, cardiologists should discuss the therapeutic options considering the patient's choices, potentially including a rehabilitation plan as part of non-pharmacological management.
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Affiliation(s)
- Miguel Santaularia-Tomas
- Subdirección de Enseñanza e Investigación, Hospital Regional de Alta Especialidad de la Peninsula de Yucatan IMSS-BIENESTAR, Merida 97130, Mexico; (E.S.-F.); (K.S.-Z.)
| | - Ely Sanchez-Felix
- Subdirección de Enseñanza e Investigación, Hospital Regional de Alta Especialidad de la Peninsula de Yucatan IMSS-BIENESTAR, Merida 97130, Mexico; (E.S.-F.); (K.S.-Z.)
| | - Kassandra Santos-Zaldivar
- Subdirección de Enseñanza e Investigación, Hospital Regional de Alta Especialidad de la Peninsula de Yucatan IMSS-BIENESTAR, Merida 97130, Mexico; (E.S.-F.); (K.S.-Z.)
| | | | - Nina Mendez-Dominguez
- Subdirección de Enseñanza e Investigación, Hospital Regional de Alta Especialidad de la Peninsula de Yucatan IMSS-BIENESTAR, Merida 97130, Mexico; (E.S.-F.); (K.S.-Z.)
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Duarte NF, de Aguiar Trigueirinho Ferreira S, Filho DAA, Vidal CHL, Lima RS, Martins AVV, Castro RO, de Assis ACR, Soares PR, Scudeler TL. Right ventricular dysfunction after pericardiectomy for tuberculous constrictive pericarditis: A case report. Clin Case Rep 2024; 12:e8899. [PMID: 38799540 PMCID: PMC11116479 DOI: 10.1002/ccr3.8899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 04/22/2024] [Accepted: 04/28/2024] [Indexed: 05/29/2024] Open
Abstract
Key Clinical MessageThis case report provides a peculiar case of tuberculous constrictive pericarditis (TCP) who presented with right ventricular dysfunction after pericardiectomy. Right ventricular dysfunction is one of the main postoperative complications after pericardiectomy. Rapid and accurate identification of right ventricular dysfunction confirmed by transthoracic echocardiography (TTE), associated with the rapid initiation of diuretics and inotropic therapy is necessary for the patient's complete recovery.AbstractTCP is a condition characterized by chronic inflammation and fibrosis of the pericardium. Pericardiectomy is the standard treatment for patients with constrictive pericarditis and persistent symptoms. One possible surgical complication is right ventricle (RV) failure. We report a case of a 44‐year‐old man who developed RV failure after pericardiectomy for TCP. A 41‐year‐old man with no medical history was referred to our hospital due to progressive dyspnea associated with edema of the lower limbs and significant weight loss (30 kg) over the past 5 months. TTE revealed significant pericardial thickening and mild pericardial effusion with normal RV function. Chest X‐ray showed moderate bilateral pleural effusion. The patient underwent pericardiectomy and bilateral pleural drainage. Histopathological examination showed tuberculosis granulomas with caseous necrosis, and antituberculosis medication was initiated. Postoperative TTEs showed normal RV function and mild pericardial thickening. The patient was discharged home after successful postoperative recovery. Three weeks later, the patient was admitted to the emergency department with dyspnea and hypoxemia. TTE revealed RV systolic dysfunction. Chest CT showed a recurrence of moderate pleural effusion, this time loculated, with restrictive atelectasis of the adjacent lung parenchyma. Diuretics and inotropic therapy were initiated, and the patient underwent lung decortication after confirmation of tuberculous empyema. The patient experienced significant clinical improvement. TTE before discharge showed a decreased RV chamber size with improved RV systolic function. The patient was discharged in a stable condition 30 days after admission with a low dose of oral furosemide. Four months after discharge, he remained asymptomatic with good functional status. Pericardiectomy for TCP may carry the risk of developing RV dysfunction. Furthermore, TCP itself may be associated with other complications, such as empyema. We emphasize the importance of conducting a thorough clinical evaluation for patients with TCP, particularly those undergoing pericardiectomy, to mitigate potential adverse outcomes.
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Affiliation(s)
- Natânia Ferreira Duarte
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | | | - Daniel Abdalla Added Filho
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Carlos Henrique Lopes Vidal
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Roger Sales Lima
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Ana Vitória Vitoreti Martins
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Rafael Oliveira Castro
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Arthur Cicupira Rodrigues de Assis
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Paulo Rogério Soares
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Thiago Luis Scudeler
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
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Ishibashi Y, Takama N, Ohtaki Y, Koitabashi N, Kurabayashi M, Ishii H. Pyothorax and Constrictive Pericarditis after Chemoradiotherapy for Esophageal Cancer. Intern Med 2024; 63:1387-1393. [PMID: 37839880 PMCID: PMC11157322 DOI: 10.2169/internalmedicine.2502-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/30/2023] [Indexed: 10/17/2023] Open
Abstract
A 75-year-old man underwent chemoradiotherapy for advanced esophageal cancer. After nine years, he was hospitalized for left pyothorax. Consequently, the patient underwent drainage and window opening surgery. He experienced cardiopulmonary arrest but was resuscitated. Based on cardiac catheterization data, the patient was diagnosed with constrictive pericarditis. Unfortunately, extracorporeal circulation did not improve his condition, and he ultimately died. An autopsy revealed adhesion between the pericardium and pleura, especially the pericardium in contact with the left thoracic cavity, which was markedly thickened. This suggests that constrictive pericarditis, a latent complication of chemoradiotherapy, is aggravated by pyothorax.
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Affiliation(s)
- Yohei Ishibashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Japan
- Department of Cardiology, National Hospital Organization Takasaki General Medical Center, Japan
| | - Noriaki Takama
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Japan
| | - Yoichi Ohtaki
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Japan
| | - Norimichi Koitabashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Japan
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Japan
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Fang L, Yu W, Yu G, Chen G, Ye B. Clinical Significance of Preoperative Pyrazinamide-Containing Therapy in Tuberculous Constrictive Pericarditis. Infect Drug Resist 2024; 17:131-139. [PMID: 38230271 PMCID: PMC10790635 DOI: 10.2147/idr.s445025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/06/2024] [Indexed: 01/18/2024] Open
Abstract
Background Tuberculous constrictive pericarditis (TCP) is recommended to be treated with anti-tuberculosis (TB) therapy before pericardiectomy. Whether different preoperative anti-TB regimens may lead to different outcomes is unclear. Methods We retrospectively collected patients diagnosed as TCP and received pericardiectomy from April 2016 to June 2023. The study patients were assigned into the active TCP (A-TCP) group and the inactive TCP (IA-TCP) group according to the results of Mycobacterium tuberculosis (MTB) culture and MTB RNA assay. Baseline characteristics including anti-TB regimens and surgical outcomes were compared between the two groups. Logistic regression analysis and subgroup analysis were conducted to identify the protective factors of A-TCP. Results Of the 102 study patients, 24 was in the A-TCP group and 78 was in the IA-TCP group. The rate of preoperative anti-TB regimen containing pyrazinamide was 37.5% in the A-TCP group, as compared with 74.4% in the IA-TCP group (P = 0.001). Multivariate analysis showed that preoperative use of pyrazinamide was the protective factor of A-TCP (OR 0.194, 95% CI 0.053-0.703, P = 0.013). Subgroup analysis based on age also showed consistent findings. In the analyses of surgical outcomes, A-TCP was the independent risk factor of postoperative cardiac complications (OR 4.231, 95% CI 1.317-13.593, P = 0.015) and associated with longer hospital stay (P = 0.004) and higher hospitalization cost (P = 0.001). Conclusion A strategy involving anti-TB regimen containing pyrazinamide before pericardiectomy was superior to that without pyrazinamide in the patients with TCP. The strategy was associated with lower risk of A-TCP and might lead to better postoperative recovery and cost-effectiveness.
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Affiliation(s)
- Likui Fang
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, 310003, People’s Republic of China
| | - Wenfeng Yu
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, 310003, People’s Republic of China
| | - Guocan Yu
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, 310003, People’s Republic of China
| | - Gang Chen
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, 310003, People’s Republic of China
| | - Bo Ye
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, 310003, People’s Republic of China
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Diaz-Arocutipa C, Chumbiauca M, Medina HM, Hernandez AV, Vicent L. Echocardiographic Criteria to Differentiate Constrictive Pericarditis From Restrictive Cardiomyopathy: A Meta-analysis. CJC Open 2023; 5:680-690. [PMID: 37744658 PMCID: PMC10516719 DOI: 10.1016/j.cjco.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/04/2023] [Indexed: 09/26/2023] Open
Abstract
Background To assess the diagnostic accuracy of the Mayo Clinic echocardiographic criteria for differentiating between constrictive pericarditis and restrictive cardiomyopathy. Methods We searched electronic databases for the date range from their inception to July 1, 2022. The index tests were the Mayo Clinic echocardiographic criteria. We performed a bivariate random-effects model to estimate the pooled sensitivity and specificity, each with 95% confidence interval (CI). The area under the curve of the summary receiver operator characteristic curves, with 95% CI, was also calculated. Results We included 17 case-control studies involving 889 patients. The pooled sensitivity and specificity (95% CI), respectively, were as follows: ventricular septal shift, 82% (60%-94%) and 78% (65%-87%); respiratory variation in mitral inflow ≥ 14.6%, 71% (51%-85%) and 82% (66%-91%); septal e' velocity ≥ 8 cm/s, 83% (80%-87%) and 90% (83%-95%); septal e' velocity/lateral e' velocity ≥ 0.88, 74% (64%-82%) and 81% (70%-88%); and hepatic vein ratio in expiration ≥ 0.79, 73% (65%-81%) and 71% (19%-96%). The area under the curve of the summary receiver operator characteristic curves varied from 0.75 to 0.85, with overlapping CIs across index tests. Conclusions Our meta-analysis suggests that all echocardiographic parameters from the Mayo Clinic criteria have good diagnostic accuracy for differentiating between constrictive pericarditis and restrictive cardiomyopathy.
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Affiliation(s)
- Carlos Diaz-Arocutipa
- Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
| | - María Chumbiauca
- Facultad de Ciencias de la Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Hector M. Medina
- Division of Cardiology, Fundacion CardioInfantil-La Cardio, Bogota, Colombia
| | - Adrian V. Hernandez
- Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, Connecticut, USA
| | - Lourdes Vicent
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Vaysblat M, Kang G, Panjwani B, Dastagir M, Roarke DT. Atypical Presentation of Constrictive Pericarditis With Constrictive Physiology on Cardiac MRI. Cureus 2023; 15:e41626. [PMID: 37575803 PMCID: PMC10412753 DOI: 10.7759/cureus.41626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Constrictive pericarditis (CP) is a disease primarily affecting the pericardial sac surrounding the heart. The constrictive physiology placed on the heart chambers can lead to clinical presentations mimicking heart failure and possibly primary liver disease. The diagnosis can often be missed and attributed to other etiologies until the patient undergoes extensive workup to rule out each potential etiology. Diagnosis can be delayed, leading to suboptimal outcomes and mortality rates. Here, we present a case of CP initially presenting with bilateral lower extremity and scrotal edema, initially attributed to alcoholic liver cirrhosis given the patient's history of alcohol abuse. Subsequent abdominal imaging found no evidence of cirrhosis, coupled with grossly normal echocardiogram that led to extensive workup and eventually the diagnosis of CP based on cardiac MRI. The patient later underwent pericardiectomy and made a full recovery. This case highlights the often ambiguous presentation of CP, the utility of cardiac MRI in diagnosis, and the need for specific criteria to help guide future diagnoses as imaging modalities continue to evolve.
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Affiliation(s)
| | | | | | - Manile Dastagir
- Internal Medicine, North Shore University Hospital, New York, USA
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Mehta A, Bansal M, Pokharel Y, Vallabhajosyula S. Constrictive Pericarditis: A Diagnostic Conundrum. Cureus 2023; 15:e39485. [PMID: 37362484 PMCID: PMC10290508 DOI: 10.7759/cureus.39485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
A 65-year-old male presented with chest pain, tachycardia, tachypnea, and diminished breath sounds. His lab investigations revealed an elevated leukocyte count, erythrocyte sedimentation rate, and B-type natriuretic peptide. Transthoracic echocardiography and chest imaging revealed the presence of pericardial effusion without tamponade and he was treated for presumed acute idiopathic pericarditis. He was started on indomethacin and colchicine but he stopped them prematurely due to side effects. Subsequently, he developed pleural effusions and ascites requiring multiple thoracenteses and paracenteses. Due to equivocal echocardiographic findings, he underwent invasive hemodynamic measurements which demonstrated equalization of filling pressures and ventricular interdependence, confirming constrictive pericarditis. Due to ongoing pericardial inflammation on cardiovascular magnetic resonance imaging, he was treated with a prednisone taper. Due to persistent symptoms and fibrosis of the pericardium on cross-section imaging, he underwent pericardiectomy. He did well with the procedure and has had an uneventful clinical follow-up.
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Affiliation(s)
- Aryan Mehta
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, USA
| | - Mridul Bansal
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, USA
| | - Yashashwi Pokharel
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, USA
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Muñoz‐Rodríguez R, Igareta‐Herraiz AT, Izquierdo‐Gómez MM, Marí‐López B, Duque‐González MA, Baeza‐Garzón F, Barragán‐Acea A, Miranda‐Bacallado J, Bosa‐Ojeda F, Lacalzada‐Almeida J. Constrictive pericarditis heart failure in a patient with atrial fibrillation: A diagnostic challenge. Clin Case Rep 2023; 11:e7166. [PMID: 37151953 PMCID: PMC10155504 DOI: 10.1002/ccr3.7166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/05/2023] [Accepted: 03/18/2023] [Indexed: 05/09/2023] Open
Abstract
Constrictive pericarditis is an infrequent cause of heart failure. Diagnosis is challenging and requires a high level of suspicion. Subtle echocardiographic findings, as the pericardial bounce, could be the clue to diagnosis.
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Affiliation(s)
| | | | | | - Belén Marí‐López
- Department of CardiologyUniversity Hospital of de Canary IslandsTenerifeSpain
| | | | - Flor Baeza‐Garzón
- Department of CardiologyUniversity Hospital of de Canary IslandsTenerifeSpain
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Shahid R, Jin J, Hope K, Tunuguntla H, Amdani S. Pediatric Pericarditis: Update. Curr Cardiol Rep 2023; 25:157-170. [PMID: 36749541 PMCID: PMC9903287 DOI: 10.1007/s11886-023-01839-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW While there have now been a variety of large reviews on adult pericarditis, this detailed review specifically focuses on the epidemiology, clinical presentation, diagnosis, and management of pediatric pericarditis. We have tried to highlight most pediatric studies conducted on this topic, with special inclusion of important adult studies that have shaped our understanding of and management for acute and recurrent pericarditis. RECENT FINDINGS We find that the etiology of pediatric pericarditis differs from adult patients with pericarditis and has evolved over the years. Also, with the current COVID-19 pandemic, it is important for pediatric clinicians to be aware of pericardial involvement both due to the infection and from vaccination. Oftentimes, pericarditis maybe the only cardiac involvement in children with COVID-19, and so caregivers should maintain a high index of suspicion when they encounter children with pericarditis. Large-scale contemporary epidemiological data regarding incidence and prevalence of both acute and recurrent pericarditis is lacking in pediatrics, and future studies should focus on highlighting this important research gap. Most of the current management strategies for pediatric pericarditis are from experiences gathered from adult data. Pediatric multicenter trials are warranted to understand the best management strategy for those with acute and recurrent pericarditis. CASE VIGNETTE A 6-year-old child with a past history of pericarditis almost 2 months ago comes in with a 2-day history of chest pain and fever. Per mother, he stopped his steroids about 2 weeks ago, and for the last 2 days has had a temperature of 102F and has been complaining of sharp mid-sternal chest pain that gets worse when he lies down and is relieved when he sits up and leans forward. On examination, he is tachycardic (heart rate 160 bpm), with normal blood pressure for age. He appears to be in pain (5/10), and on auscultation has a pericardial friction rub. His lab studies are notable for elevated white blood cell count and inflammatory markers (CRP and ESR). His electrocardiogram reveals sinus tachycardia and diffuse ST-elevation in all precordial leads. His echocardiogram demonstrates normal biventricular function and a trace pericardial effusion. His cardiac MRI confirms recurrent pericarditis. He is started on indomethacin and colchicine. He has complete resolution of his symptoms by day 3 of admission and is discharged with close follow-up.
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Affiliation(s)
- Rida Shahid
- grid.239578.20000 0001 0675 4725Department of Pediatric Cardiology, Cleveland Clinic Children’s Hospital, Cleveland, OH USA
| | - Justin Jin
- grid.413808.60000 0004 0388 2248Division of Pediatric Cardiology, Northwestern Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Kyle Hope
- grid.39382.330000 0001 2160 926XLillie Frank Abercrombie Division of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
| | - Hari Tunuguntla
- grid.39382.330000 0001 2160 926XLillie Frank Abercrombie Division of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
| | - Shahnawaz Amdani
- grid.239578.20000 0001 0675 4725Department of Pediatric Cardiology, Cleveland Clinic Children’s Hospital, Cleveland, OH USA
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Yi D, Li L, Han M, Qiu R, Tao L, Liu L, Liu C. Case report: Mechanical-electric feedback and atrial fibrillation-Revelation from the treatment of a rare atrial fibrillation caused by annular constrictive pericarditis. Front Cardiovasc Med 2023; 10:1100425. [PMID: 36760571 PMCID: PMC9905231 DOI: 10.3389/fcvm.2023.1100425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
Atrial fibrillation (AF) is one of the most common arrhythmias encountered in clinical practice. The pathophysiological mechanisms responsible for its development are complex, vary amongst individuals, and associated with predisposing factors. Here, we report a case of AF caused by annular constrictive pericarditis (ACP), which is extremely rare due to its unusual anatomical form. In our patient, AF was refractory to multiple antiarrhythmic medications; however, spontaneous conversion to sinus rhythm occurred when the ring encircling the right and left ventricular (RV and LV) cavities along the atrioventricular (AV) groove was severed. This suggests that atrial stretch due to atrial enlargement and increased left atrial (LA) pressure may contribute to the initiation and maintenance of AF. This report highlights the importance of the careful investigation of rare predisposing factors for AF using non-invasive diagnostic approaches and mechanical-electric feedback (MEF) as a pathophysiological mechanism for AF initiation and maintenance.
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Affiliation(s)
- Dong Yi
- Division of Cardiac Care Unit, Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Lei Li
- Division of Cardiac Care Unit, Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Min Han
- Division of Cardiac Care Unit, Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Rujie Qiu
- Division of Cardiac Care Unit, Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Liang Tao
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Li Liu
- Division of Cardiac Care Unit, Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, Hubei, China,*Correspondence: Li Liu,
| | - Chengwei Liu
- Division of Cardiac Care Unit, Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, Hubei, China,Chengwei Liu,
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Kaur J, Xu J, Alturkmani HJ, Al’Aref S, Dhar G. Severely Calcified Pericardium Causing Constrictive Pericarditis. Methodist Debakey Cardiovasc J 2023; 19:7-11. [PMID: 36698864 PMCID: PMC9838225 DOI: 10.14797/mdcvj.1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/06/2022] [Indexed: 01/14/2023] Open
Abstract
Constrictive pericarditis (CP) is a type of diastolic heart failure caused by an inelastic pericardium that impairs cardiac filling. Diagnosing CP can be challenging, and a variety of imaging techniques may be necessary. We present a unique case of severely calcified pericardium leading to CP.
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Affiliation(s)
- Jagdeep Kaur
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, US
| | - Jack Xu
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, US
| | | | - Subhi Al’Aref
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, US
| | - Gaurav Dhar
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, US
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13
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Oh NA, Hennecken C, Van den Eynde J, Doulamis IP, Avgerinos DV, Kampaktsis PN. Pericardiectomy and Pericardial Window for the Treatment of Pericardial Disease in the Contemporary Era. Curr Cardiol Rep 2022; 24:1619-1631. [PMID: 36029363 DOI: 10.1007/s11886-022-01773-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW To summarize the contemporary practice of pericardiectomy and pericardial window. We discuss the indications, preoperative planning, procedural aspects, postprocedural management, and outcomes of each procedure. RECENT FINDINGS Surgical approaches for the treatment of pericardial disease have been around even before the emergence of cardiopulmonary bypass. Since the forthcoming of cardiopulmonary bypass, there have been significant changes in the epidemiology and diagnostic approach of pericardial diseases as well as advancements in the surgical techniques and perioperative management used in the care of these patients. Pericardiectomy has an average mortality of almost 7% and is typically performed in patients with advanced symptoms from constrictive pericarditis and relatively few comorbidities. Pericardial window is a safe procedure for the treatment of pericardial effusion that can be performed with different approaches.
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Affiliation(s)
- Nicholas A Oh
- Department of Cardiothoracic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Carolyn Hennecken
- Division of Cardiology, New York Presbyterian Hospital, Columbia University Irving Medical Center, 177 Fort Washington Av, New York, NY, 10032, USA
| | - Jef Van den Eynde
- The Johns Hopkins Hospital and School of Medicine, Helen B. Taussig Heart Center, Baltimore, MD, USA
- Department of Cardiovascular Sciences, KU Leuven, Louvain, Belgium
| | - Ilias P Doulamis
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dimitrios V Avgerinos
- Third Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Polydoros N Kampaktsis
- Division of Cardiology, New York Presbyterian Hospital, Columbia University Irving Medical Center, 177 Fort Washington Av, New York, NY, 10032, USA.
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14
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Hajsadeghi S, Gholizadeh Mesgarha M, Saberi Shahrbabaki E, Pishgahi M, Ebadi Fard Azar A, Pour Mohammad A. Constrictive pericarditis following inactivated virus COVID-19 vaccine: a case report with review of the literature. Radiol Case Rep 2022; 17:3774-3778. [PMID: 35950151 PMCID: PMC9355495 DOI: 10.1016/j.radcr.2022.07.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022] Open
Abstract
Cardiac adverse effects of the COVID-19 vaccine are very rare, myocarditis and pericarditis are the most common amid them, and constrictive pericarditis (CP) is reported to be restricted to a few cases following mRNA COVID-19 vaccines. We report a case of a 72-year-old male patient who developed symptoms of right-sided heart failure, which started after 8 days of receiving the third dose of inactivated virus COVID-19 vaccine and his diagnostic tests comprising transthoracic echocardiography, chest CT scan, cardiac magnetic resonance were in favor of CP. Ultimately, invasive cardiac catheterization confirmed the diagnosis of CP. Due to the lack of satisfactory response to corticosteroid therapy, pericardiectomy was performed, which gave rise to symptom relief progressively and substantially. Considering the temporal course of the patient's symptoms and exclusion of other possible etiologies based on the patient's medical history and diagnostic evaluation, immunization with the COVID-19 vaccine was recognized as a culprit for developing CP. Despite being a scarce phenomenon, the COVID-19 vaccine could have a tendency to provoke pericardial inflammation in so far as causing CP. Hence, physicians should have a high index of suspicion in these circumstances and accelerate the diagnostic investigation.
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15
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Sohal S, Mathai SV, Lipat K, Kaur A, Visveswaran G, Cohen M, Waxman S, Tiwari N, Vucic E. Multimodality Imaging of Constrictive Pericarditis: Pathophysiology and New Concepts. Curr Cardiol Rep 2022; 24:1439-1453. [PMID: 35917048 PMCID: PMC9344806 DOI: 10.1007/s11886-022-01758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/15/2022]
Abstract
Purpose of Review The unique pathophysiological changes of constrictive pericarditis (CP) can now be identified with better imaging modalities, thereby helping in its early diagnosis. Through this review, we outline the pathophysiology of CP and its translation into symptomology and various imaging findings which then are used for both diagnosis and guiding treatment options for CP. Recent Findings Multimodality imaging has provided us with the capability to recognize early stages of the disease and identify patients with a potential for reversibility and can be treated with medical management. Additionally, peri-procedural planning and prediction of post-operative complications has been made possible with the use of advanced imaging techniques. Summary Advanced imaging has the potential to play a greater role in identification of patients with reversible disease process and provide peri-procedural risk stratification, thereby improving outcomes for patients with CP.
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Affiliation(s)
- Sumit Sohal
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA.
| | - Sheetal Vasundara Mathai
- Division of Cardiovascular Diseases, Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Kevin Lipat
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Arpanjeet Kaur
- Department of Medicine, Mount Sinai West, 1000 Tenth Avenue, New York, NY, 10019, USA
| | - Gautam Visveswaran
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Marc Cohen
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Sergio Waxman
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Nidhish Tiwari
- Division of Cardiovascular Diseases, Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Esad Vucic
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
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16
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Khan HMW, Munir A, Sud A, Moza A. Heart in a shell—a cascade of classical findings: a case report. Eur Heart J Case Rep 2022; 6:ytac231. [PMID: 35757583 PMCID: PMC9214780 DOI: 10.1093/ehjcr/ytac231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/18/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022]
Abstract
Background Idiopathic chronic constrictive pericarditis (CP) is an uncommon yet very important clinical entity as prompt diagnosis and early treatment are affiliated with improved outcomes. We describe an uncommon case of CP with a series of textbook findings and received successful treatment with surgical pericardiectomy (SP). Case summary A 58-year-old male presented to the emergency department with exertional dyspnoea and anasarca. The past medical history was negative for infections like tuberculosis, viral, etc., connective tissue disease, prior cardiac surgery, human immunodeficiency virus, or any radiation therapy. The vital signs were within normal limits except mild hypoxia while the physical examination was consistent with congestive heart failure. Further investigations with laboratory testing, imaging with chest X-ray, computed tomography, echocardiogram, and invasive study with right heart catheterization were all consistent with idiopathic chronic CP. The patient underwent successful SP with significant improvement in clinical condition. Discussion This case highlights the classical signs and symptoms along with important diagnostic features of CP. It is uncommon to see all the classical features of CP in one patient as described in the above case. Familiarity with these findings is crucial to make the diagnosis as early treatment is affiliated with improved outcomes.
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Affiliation(s)
| | - Ahmad Munir
- Department of Cardiovascular Disease, Michigan State University/McLaren , 48532 Flint, MI , USA
| | - Anup Sud
- Department of Cardiothoracic Surgery, Michigan State University/McLaren , 48532 Flint, MI , USA
| | - Ankush Moza
- Department of Cardiovascular Disease, Michigan State University/McLaren , 48532 Flint, MI , USA
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17
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Head-to-head comparison of the diagnostic value of five tests for constrictive tuberculous pericarditis. Int J Infect Dis 2022; 120:25-32. [DOI: 10.1016/j.ijid.2022.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/20/2022] [Accepted: 04/08/2022] [Indexed: 11/19/2022] Open
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18
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Fang L, Yu W, Yu G, Ye B, Chen G. Predictive value of matrix metalloprotease 9 on surgical outcomes after pericardiectomy. J Cardiothorac Surg 2022; 17:50. [PMID: 35321732 PMCID: PMC8943958 DOI: 10.1186/s13019-022-01796-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effects of matrix metalloproteases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) expressions on the patients with constrictive pericarditis undergoing pericardiectomy remain unclear. This study explored the associations of MMPs and TIMPs expressions with postoperative outcomes in these patients. METHODS Pericardial specimens were obtained during pericardiectomy from the patients with constrictive pericarditis. The levels of MMP1, MMP2, MMP9 and TIMP1 in pericardium were analyzed by quantitative real-time polymerase chain reaction. The enrolled patients were divided into two groups according to the optimal cutoff value of gene expression predicting postoperative complications. Postoperative outcomes were compared between the two groups. Binary logistic regression analysis was performed to determine the degree of contribution of gene expression on postoperative outcomes. RESULTS A total of 22 patients and their pericardial specimens were included. The level of MMP9 was significantly associated with postoperative complications and the optimal cutoff value predicting postoperative complications was 3.67. The patients with low level of MMP9 (< 3.67) had lower incidence of postoperative complications (P = 0.002), shorter postoperative intensive care unit (P = 0.040) and hospital stay (P = 0.043) in comparison to those with high level of MMP9 (≥ 3.67). Binary logistic regression analysis showed that high level of MMP9 increased the risk of postoperative complications (OR 27.096, 95% CI 1.166-629.886, P = 0.040). CONCLUSIONS High level of MMP9 in the pericardium was associated with poor postoperative outcomes and was the independent risk factor of postoperative complications. The level of MMP9 could be used as a potential marker for prediction of surgical outcomes.
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Affiliation(s)
- Likui Fang
- Department of Thoracic Surgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Wenfeng Yu
- Department of Thoracic Surgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Guocan Yu
- Department of Thoracic Surgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Bo Ye
- Department of Thoracic Surgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Gang Chen
- Department of Thoracic Surgery, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
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19
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Benjamin SR, Mohammad A, Shankar R, Kuruvilla KT, Philip MA, Thankachen R, Gnanamuthu BR, Kesavan P. Does tuberculosis affect surgical outcomes following pericardiectomy for chronic constrictive pericarditis? Twelve years’ experience from a tertiary care center in India. Indian J Thorac Cardiovasc Surg 2022; 38:241-250. [PMID: 35529004 PMCID: PMC9023633 DOI: 10.1007/s12055-021-01313-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 12/04/2021] [Accepted: 12/07/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction and purpose Tuberculosis (TB) is the commonest cause of chronic constrictive pericarditis (CCP) in India, unlike in the western countries. Pericardiectomy is the treatment of choice for CCP. Surgery in TB CCP is considerably more difficult than it is for other etiologies. The role of TB as an independent predictor for adverse surgical outcomes had not been properly evaluated in the Indian scenario. Hence, the aim of this study was to retrospectively analyze our results of surgery for CCP and the pre-operative factors that influenced post-operative outcomes. Methods The data of all adult patients who underwent pericardiectomy for CCP, between the years 2009 and 2020, maintained in a live database in our institute, were retrieved and analyzed. Results There were 124 patients in the study. The average age was 32 years. The male to female ratio was 3:1. TB was the commonest cause of CCP, identified in 64 (51.6%) patients. Complete anterior pericardiectomy (CAP) was possible in 122 (98.3%) patients. All the patients had significant drop in their central venous pressure (CVP) (10.25 ± 3.47 mmHg) after surgery. The operative time (p = 0.008), intra-operative blood loss (p = 0.02), intensive care unit (ICU) stay (p = 0.03), and hospital stay (p = 0.028) were significantly higher in the TB group. Apart from TB, the other pre-operative variables that predicted adverse outcomes were male sex, presence of pleural effusion or ascites, and advanced New York Heart Association (NYHA) class. There were 7 (5.6%) post-operative complications and 3 (2.4%) in-hospital deaths. Conclusion The high incidence of TB CCP makes a pericardiectomy in developing countries technically more challenging resulting in increased operative time, more blood loss, and prolonged ICU and hospital stay, but did not affect in-hospital mortality or morbidity.
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Affiliation(s)
- Santhosh Regini Benjamin
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
| | - Aamir Mohammad
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
| | - Ravi Shankar
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
| | - Korah Thomas Kuruvilla
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
| | - Madhu Andrew Philip
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
| | - Roy Thankachen
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
| | - Birla Roy Gnanamuthu
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
| | - Premprasath Kesavan
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
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20
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Zhao X, Li C, Zhong Y, Mao X, Liu G, Wang F, Liang G. Follow-Up at 2 years After Emergency Surgery for Constrictive Pericarditis Complicated With Gastrointestinal Bleeding. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2022; 59:469580211064462. [PMID: 35044271 PMCID: PMC8785284 DOI: 10.1177/00469580211064462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic constrictive pericarditis (CCP) is one of the common causes of cardiogenic cirrhosis; it is rare for a patient to have both CCP and recurrent black stool, so we consider that CCP causes cardiogenic cirrhosis. Cardiogenic cirrhosis caused portal hypertension which then resulted in gastrointestinal bleeding. Herein, we report a case of a 40-year-old Chinese woman suffering from CCP who had upper gastrointestinal bleed and had to undergo emergency surgery. Two years after the emergency surgery, multiple reexaminations showed significantly improved cardiac functions, hemoglobin, and WBC levels and gastrointestinal functions.
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Affiliation(s)
- Xu Zhao
- Department of Cardiothoracic Surgery, 66367The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China.,66367Zunyi Medical University, Zunyi, China.,Department of Cardiothoracic Surgery159358, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Chuntian Li
- Department of Cardiothoracic Surgery, 66367The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China.,66367Zunyi Medical University, Zunyi, China.,Department of Cardiothoracic Surgery159358, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yue Zhong
- Department of Cardiothoracic Surgery, 66367The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China.,66367Zunyi Medical University, Zunyi, China.,Department of Cardiothoracic Surgery159358, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xin Mao
- Department of Cardiothoracic Surgery, 66367The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China.,66367Zunyi Medical University, Zunyi, China.,Department of Cardiothoracic Surgery159358, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Guiqing Liu
- Department of Cardiothoracic Surgery, 129363Hammersmith Hospital, London, UK
| | - Feng Wang
- Department of Cardiothoracic Surgery, 66367The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Cardiothoracic Surgery159358, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Guizhou Medical University, Translational Medicine Centre, Guiyang, China
| | - Guiyou Liang
- Guizhou Medical University, Translational Medicine Centre, Guiyang, China
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21
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Diaz-Arocutipa C, Saucedo-Chinchay J, Imazio M, Argulian E. Natriuretic peptides to differentiate constrictive pericarditis and restrictive cardiomyopathy: A systematic review and meta-analysis. Clin Cardiol 2021; 45:251-257. [PMID: 34967020 PMCID: PMC8922532 DOI: 10.1002/clc.23772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/06/2021] [Accepted: 12/21/2021] [Indexed: 11/11/2022] Open
Abstract
Previous studies have shown that natriuretic peptide levels are increased in patients with restrictive cardiomyopathy (RCM) but not in constrictive pericarditis (CP). We performed a systematic review and meta-analysis to evaluate the diagnostic utility of B-type natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) to differentiate CP and RCM. We searched electronic databases from inception to January 07, 2021. Studies involving adult patients that assessed the utility of natriuretic peptides to differentiate CP and RCM were included. All meta-analyses were performed using a random-effects model. Seven studies (four case-control and three cohorts) involving 204 patients were included. The mean age ranged between 25.7 and 64.1 years and 77% of patients were men. BNP levels were significantly lower (standardized median difference [SMD], -1.48; 95% confidence interval [CI], -2.33 to -0.63) in patients with CP compared to RCM. The pooled area under the curve (AUC) of the BNP level was 0.81 (95% CI, 0.70-0.92). NT-proBNP (SMD, -0.86; 95% CI, -1.38 to -0.33) and log NT-proBNP (SMD, -1.89; 95% CI, -2.59 to -1.20) levels were significantly lower in patients with CP compared to RCM. Our review shows that BNP and NT-proBNP levels were significantly lower in patients with CP compared to RCM. The pooled AUC of BNP level showed a good diagnostic accuracy to differentiate both conditions.
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Affiliation(s)
- Carlos Diaz-Arocutipa
- Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru.,Programa de Atención Domiciliaria, EsSalud, Lima, Peru.,Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS), Lima, Peru
| | | | - Massimo Imazio
- Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Edgar Argulian
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, USA
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22
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Hasnie AA, Miller NJ, Davies J, Von Mering G. Constrictive Pericarditis Presenting as Isolated Ascites. Radiol Case Rep 2021; 17:259-264. [PMID: 34849181 PMCID: PMC8609104 DOI: 10.1016/j.radcr.2021.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 11/24/2022] Open
Abstract
Constrictive pericarditis is a rare cause of right-sided heart failure secondary to a stiff, non-compliant pericardium. Clinical presentation can vary considerably and requires a high suspicion for diagnosis. A 31-year-old male presented to the emergency department with complaints of abdominal distension. An abdominal ultrasound revealed large volume ascites; thus, it was initially suspected he had underlying cirrhosis. However, an echocardiogram revealed a diagnosis of constrictive pericarditis. It's important for clinicians to consider constrictive pericarditis in a patient presenting with unexplained right-sided heart failure.
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Affiliation(s)
- Ammar A Hasnie
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Neal J Miller
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - James Davies
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Gregory Von Mering
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233 USA
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23
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24
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An KR, Singh SK. Péricardite constrictive accompagnée de calcification péricardique. CMAJ 2021; 193:E1328-E1329. [PMID: 34426455 PMCID: PMC8412421 DOI: 10.1503/cmaj.202346-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Kevin R An
- Division de chirurgie cardiaque, Partenaires de santé Trillium, Université de Toronto, Toronto, Ont
| | - Steve K Singh
- Division de chirurgie cardiaque, Partenaires de santé Trillium, Université de Toronto, Toronto, Ont.
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25
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Brown MT, McDowell AC, Clements SD, Dressler DD. Here's the rub: A case of constrictive pericarditis in an adult with cystic fibrosis. Respir Med Case Rep 2021; 33:101434. [PMID: 34401277 PMCID: PMC8349017 DOI: 10.1016/j.rmcr.2021.101434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 05/18/2021] [Accepted: 05/27/2021] [Indexed: 11/21/2022] Open
Abstract
We present a rare coexistence of constrictive pericarditis in a patient with cystic fibrosis. Careful attention to cardiac friction rub auscultated on initial examination prompted echocardiography revealing constrictive pericarditis further confirmed by cardiac magnetic resonance imaging that allowed for dedicated treatment in addition to management of his concurrent respiratory infection. Only the third reported case of constrictive pericarditis in a patient with cystic fibrosis. Symptoms of severe cystic fibrosis and constrictive pericarditis are similar. Cardiac knocks or friction rubs should raise suspicion for a pericardial process. Annulus paradoxus and reversus are echo hallmarks for constrictive pericarditis. Management of constrictive pericarditis requires dedicated treatment and monitoring.
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Affiliation(s)
- Matthew T Brown
- J Willis Hurst Internal Medicine Residency Program, USA.,Department of Medicine, Emory University, Atlanta, GA, USA
| | - Ashley C McDowell
- J Willis Hurst Internal Medicine Residency Program, USA.,Department of Medicine, Emory University, Atlanta, GA, USA
| | - Stephen D Clements
- Department of Medicine, Emory University, Atlanta, GA, USA.,Division of Cardiology, USA
| | - Daniel D Dressler
- J Willis Hurst Internal Medicine Residency Program, USA.,Department of Medicine, Emory University, Atlanta, GA, USA.,Division of Hospital Medicine, USA
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26
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Yang JH, Miranda WR, Nishimura RA, Greason KL, Schaff HV, Oh JK. Prognostic importance of mitral e' velocity in constrictive pericarditis. Eur Heart J Cardiovasc Imaging 2021; 22:357-364. [PMID: 32514577 DOI: 10.1093/ehjci/jeaa133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS Increased medial mitral annulus early diastolic velocity (e') plays an important role in the echocardiographic diagnosis of constrictive pericarditis (CP) and mitral e' velocity is also a marker of underlying myocardial disease. We assessed the prognostic implication of mitral e' for long-term mortality after pericardiectomy in patients with CP. METHODS AND RESULTS We studied 104 surgically confirmed CP patients who underwent echocardiography and cardiac catheterization within 7 days between 2005 and 2013. Patients were classified as primary CP (n = 45) or mixed CP (n = 59) based on the clinical history of concomitant myocardial disease. On multivariable analysis, medial e' velocity and mean pulmonary artery pressure were independently associated with long-term mortality post-pericardiectomy. There were significant differences in survival rates among the groups divided by cut-off values of 9.0 cm/s and 29 mmHg for medial e' and mean pulmonary artery pressure, respectively (both P < 0.001). Ninety-two patients (88.5%) had elevated pulmonary artery wedge pressure (PAWP) (≥15 mmHg); there was no significant correlation between medial E/e' and PAWP (r = 0.002, P = 0.998). However, despite the similar PAWP between primary CP and mixed CP groups (21.6 ± 5.4 vs. 21.2 ± 5.8, P = 0.774), all primary CP individuals with elevated PAWP had medial E/e' <15 as opposed to 34 patients (57.6%) in the mixed CP group (P < 0.001). CONCLUSION Increased mitral e' velocity is associated with better outcomes in patients with CP. A paradoxical distribution of the relationship between E/e' and PAWP is present in these patients but there is no direct inverse correlation between them.
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Affiliation(s)
- Jeong Hoon Yang
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.,Division of Cardiology, Department of Critical Care Medicine and Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.,Division of Cardiology, Department of Critical Care Medicine and Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
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27
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An KR, Singh SK. Constrictive pericarditis with pericardial calcification. CMAJ 2021; 193:E853. [PMID: 34099470 PMCID: PMC8203255 DOI: 10.1503/cmaj.202346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Kevin R An
- Division of Cardiac Surgery, Trillium Health Partners, University of Toronto, Toronto, Ont
| | - Steve K Singh
- Division of Cardiac Surgery, Trillium Health Partners, University of Toronto, Toronto, Ont.
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28
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Schmitt EG, Dalal AS, Kothari A, Kitcharoensakkul M. The Heart of the Matter: Secondary Hypogammaglobulinemia and Constrictive Pericarditis. Pediatrics 2021; 147:peds.2020-021808. [PMID: 34049957 PMCID: PMC8893353 DOI: 10.1542/peds.2020-021808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 11/24/2022] Open
Abstract
Constrictive pericarditis is the final common result of a number of processes that affect the pericardium. Establishing the diagnosis and determining the underlying etiology of constrictive pericarditis are often a diagnostic rendezvous. Here, we describe a patient who presented to the general practitioner with edema, ascites, and weight gain and was found to have constrictive pericarditis secondary to an inflammatory myofibroblastic tumor of the mediastinum. Interestingly, she had a relative lack of cardiorespiratory complaints, and, aside from the edema and mildly elevated jugular venous pressure, she had an unremarkable cardiac and pulmonary examination. During the diagnostic evaluation for constrictive pericarditis, she was found to have hypogammaglobulinemia and profound lymphocytopenia. A stool α-1-antitrypsin level was sent and was elevated, which confirmed the diagnosis of protein-losing enteropathy, a rare but important complication of constrictive pericarditis. This case highlights important diagnostic considerations and management of these complications for the general practitioner.
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Affiliation(s)
- Erica G. Schmitt
- Department of Pediatrics, Division of Rheumatology and Immunology, Washington University School of Medicine, One Children’s Place, Campus Box 8116, St. Louis, MO, USA
| | - Aarti S. Dalal
- Department of Pediatrics, Division of Cardiology, Washington University School of Medicine
| | - Alok Kothari
- Department of Pediatrics, Division of Hematology and Oncology, Washington University School of Medicine
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29
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Malakan Rad E, Yaghmaei B, Ziaee V, Beirami F, Pouraliakbar H. Multimodality imaging of constrictive pericarditis in H syndrome. Echocardiography 2021; 38:1021-1032. [PMID: 33899966 DOI: 10.1111/echo.15027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/12/2021] [Accepted: 02/26/2021] [Indexed: 11/28/2022] Open
Abstract
This is the first report of constrictive pericarditis (CP) in a 16-year-old boy with H syndrome with pericardial involvement predominantly over the right ventricle with favorable response to anti-inflammatory treatment. H syndrome, first reported in 2008, is a new auto-inflammatory syndrome with multiorgan involvement due to mutation in the SLC29A3 gene. We described the echocardiographic characteristics of asymmetric pericardial involvement and presented the cardiac computed tomography angiographic and magnetic resonance imaging findings. We reviewed the echocardiographic signs of CP, introduced tricuspid E/A respiratory alternans as a novel echocardiographic sign of right ventricular dominant CP, and explained the underlying mechanism.
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Affiliation(s)
- Elaheh Malakan Rad
- Department of Pediatric Cardiology, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Yaghmaei
- Department of Pediatric Intensive Care, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Ziaee
- Department of Pediatrics, Tehran University of Medical Science, Tehran, Iran.,Children's Medical Center, Pediatric Center of Excellence, Tehran, Iran.,Pediatric Rheumatology Research Group, Rheumatology Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Farzaneh Beirami
- Department of Pediatric Intensive Care, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
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30
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Qiao W, Xiao YJ, Wang X, Sun LJ, Chen YX, Ren WD. A novel model of constrictive pericarditis associated with myocardial fibrosis in rats. Clin Exp Pharmacol Physiol 2021; 48:563-574. [PMID: 33349990 DOI: 10.1111/1440-1681.13449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 11/29/2020] [Indexed: 12/15/2022]
Abstract
An efficient animal model is fundamental for studies on the underlying mechanisms of constrictive pericarditis (CP). A novel CP rat model was established by pericardial injection composing of lipopolysaccharides (LPS) and talcum powder without thoracotomy. Pathological changes were confirmed by histological staining. E-flow Doppler of mitral valve, tissue Doppler E' in the medial mitral annular (E'sep ) and the lateral mitral annular (E'lat ) were measured to assess ventricular filling function. Circumferential, longitudinal, and radial strains (SC, SL and SR) and the respective strain rates (SrC, SrL and SrR) were analyzed in interventricular septum (IVS) and left ventricular free wall (LVFW). Rat cardiac fibroblasts (CFs) were treated with LPS. The activation of transforming growth factor β1 (TGF-β1) was confirmed by Q-PCR and western blot assays. Thickening of pericardium and fibrosis in pericardium and subepicardial myocardium were showed in the model group. Diastolic dysfunction in the CP group was indicated by decreased E'lat and E'lat /E'sep , increased E/E'lat , decreased EFW of SrC and SrL, increased AIVS and decreased E/A of SrC, SrL and SrR. Systolic dysfunction was indicated by decreased SCFW and SLFW in CP rats. The levels of TGF-β1, p-Smad2/3, α-smooth muscle actin (α-SMA), and collagen-I/III (COL-I/III) were increased in the CP group. The increased TGF-β1 that induced by LPS activated and phosphorylated Smad2/3 resulting in the secretion of α-SMA and COL-I/III. This model is of vital importance in studying the pathogenesis of CP.
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Affiliation(s)
- Wei Qiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang-Jie Xiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xin Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Li-Juan Sun
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Ultrasound, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Yi-Xin Chen
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wei-Dong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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31
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Berger JH, Jones A, Fainberg N, Smith C, Ravishankar C. A Previously Healthy Teenager with Anasarca. Pediatr Rev 2021; 42:153-157. [PMID: 33648995 PMCID: PMC8034987 DOI: 10.1542/pir.2020-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Nina Fainberg
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
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32
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Chetrit M, Parent M, Klein AL. Multimodality imaging in pericardial diseases. Panminerva Med 2021; 63:301-313. [PMID: 33618512 DOI: 10.23736/s0031-0808.21.04270-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
With a rapidly growing spectrum, non-specific symptoms and overlapping etiologies, pericardial diseases can represent a real diagnostic challenge. Consequently, multimodality imaging has taken a front seat in the diagnosis and management of these conditions. Cardiac CT offers an excellent anatomical characterization of pericardial thickening, fat stranding and/or presence of calcifications. and is also the preferred modality to assess extra-cardiac structures. Active pericardial inflammation, edema and fibrosis comprise pericardial characterization using CMR and allows for a precise diagnosis, disease staging and patient specific tailoring of therapies. PET scan still occupies a very modest role in the evaluation of pericardial diseases, but might help discriminating malignant pericardial effusion and extra-pulmonary tuberculous. More than ever, clinicians need to master how these modalities complement each other while avoiding unnecessary cost and to translate this knowledge into a more customized patient's care approach. The aim of this review is to recognize the role of multimodality imaging in the investigation of various pericardial diseases, assess how these modalities can impact the clinical course and treatment of these affections and finally elucidate their role in the patient's prognostication.
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Affiliation(s)
- Michael Chetrit
- Department of Cardiovascular Medicine, McGill University, Montreal, Canada
| | - Martine Parent
- Department of Cardiovascular Medicine, McGill University, Montreal, Canada
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Cleveland Clinic, Cleveland, OH, USA - .,Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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33
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Ouarrak S, El Ouali Z, Habbal R. Contribution of Chest Radiography in Calcific Constrictive Pericarditis: A Massive Hull Around the Heart. CJC Open 2020; 2:741-742. [PMID: 33305243 PMCID: PMC7711022 DOI: 10.1016/j.cjco.2020.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/18/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Safia Ouarrak
- Department of Cardiology, University Hospital of Ibn Rochd, Casablanca, Morocco
- Corresponding author: Safia Ouarrak, Department of Cardiology, University Hospital of Ibn Rochd, 1 rue des hôpitaux, Casablanca, 20250, Morocco. Tel.: +212-671-139513.
| | - Zakaria El Ouali
- Department of Rheumatology, University Hospital of Ibn Rochd, Casablanca, Morocco
| | - Rachida Habbal
- Department of Cardiology, University Hospital of Ibn Rochd, Casablanca, Morocco
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34
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Bhattad PB, Jain V. Constrictive Pericarditis: A Commonly Missed Cause of Treatable Diastolic Heart Failure. Cureus 2020; 12:e8024. [PMID: 32528763 PMCID: PMC7282374 DOI: 10.7759/cureus.8024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Constrictive pericarditis arises as a result of the fibrous thickening of the pericardium due to chronic inflammatory changes from various injuries. Increased pulmonary and systemic venous pressures manifest clinical features of left and right heart failure. Idiopathic or post-viral pericarditis is the most common cause followed by postpericardiotomy, radiation-induced causes. Right-sided heart failure symptoms predominate over left-sided heart failure symptoms due to the equalization of pressures. No single diagnostic test can provide a definitive diagnosis or evidence of constrictive pericarditis. Medical management is difficult for constrictive pericarditis. The treatment of choice for constrictive pericarditis is pericardiectomy.
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Affiliation(s)
| | - Vinay Jain
- Radiology, James H. Quillen Veterans Affairs Medical Center, Johnson City, USA
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35
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Senoner T, Sakic A, Sarcletti M, Dichtl W, Feuchtner GM. Nontuberculous extensive constrictive pericarditis calcarea impairing right ventricular filling in an HIV-infected patient: the key role of computed tomography imaging. J Cardiovasc Med (Hagerstown) 2020; 21:532-534. [PMID: 32251076 DOI: 10.2459/jcm.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | - Gudrun M Feuchtner
- Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
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36
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Helwani MA, Alber S, DeWet CJ, Zoller JK. Intraoperative Assessment of Hepatic Vein Tracings in Constrictive Pericarditis During Surgical Pericardiectomy. J Cardiothorac Vasc Anesth 2020; 34:1099-1102. [DOI: 10.1053/j.jvca.2019.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/04/2019] [Accepted: 11/09/2019] [Indexed: 11/11/2022]
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37
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Abstract
Abstract
Purpose of Review
To review the latest developments and the current role of the cardiac magnetic resonance (CMR) in pericardial diseases and their complications.
Recent Findings
Cardiac Magnetic Resonance (CMR) has the ability to incorporate anatomy, physiology, and “virtual histology” strategies to achieve the most accurate diagnosis for even the most demanding, pericardial diseases.
Summary
Acute, chronic, recurrent, and constrictive pericarditis as well as pericarditis related complications, pericardial masses and congenital pericardial defects are commonly encountered in clinical practice with relatively significant morbidity and mortality. Owing to the challenging diagnosis, CMR imaging is often employed in confirming the diagnosis and elucidating the underling pathophysiology. In this review we outline the common CMR techniques and their expected diagnostic outcomes.
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38
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Vogt JC, Nishimura RA, Newman DB. Middle-aged Man With Exertional Dyspnea and Neck Fullness. JAMA Cardiol 2019; 4:1045-1046. [DOI: 10.1001/jamacardio.2019.1677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Joshua C. Vogt
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rick A. Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - D. Brian Newman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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39
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Lima NDA, Lino DODC, Coelho NM, Melgar T. Tuberculous constrictive pericarditis. BMJ Case Rep 2019; 12:12/7/e230420. [PMID: 31278202 DOI: 10.1136/bcr-2019-230420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Neiberg de Alcantara Lima
- Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | | | | | - Thomas Melgar
- Internal Medicine/Pediatrics, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
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40
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Gatti G, Fiore A, Ternacle J, Porcari A, Fiorica I, Poletti A, Ecarnot F, Bussani R, Pappalardo A, Chocron S, Folliguet T, Perrotti A. Pericardiectomy for constrictive pericarditis: a risk factor analysis for early and late failure. Heart Vessels 2019; 35:92-103. [DOI: 10.1007/s00380-019-01464-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/21/2019] [Indexed: 12/13/2022]
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41
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Patel S, Ross L, McKelvie P, Nikpour M. Constrictive pericarditis as the presenting manifestation of systemic sclerosis. Rheumatology (Oxford) 2019; 58:732-734. [PMID: 30590804 DOI: 10.1093/rheumatology/key404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Shreeya Patel
- Department of Rheumatology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Laura Ross
- Department of Rheumatology, St Vincent's Hospital, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, VIC, Australia
| | - Penny McKelvie
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, VIC, Australia.,Department of Anatomical Pathology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Mandana Nikpour
- Department of Rheumatology, St Vincent's Hospital, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, VIC, Australia
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