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Chronic constrictive pericarditis is a pericardial affection that causes a severe impairment of myocardial compliance. Among its many etiologies, tuberculosis is the most common cause, mainly in developing countries. Multimodal imaging methods are essential tools for guiding diagnosis. We present the case of a 64-year-old man with no past medical history who presented with dyspnea stage II of NYHA and right heart failure. At admission, he was stable, with normal blood pressure and a normal heart rate. His ECG showed a low voltage of QRS complexes. Transthoracic echocardiography revealed significant pericardial thickening enveloping the ventricles, with significant respiratory flow variation. A thoracic CT scan and cardiac MRI confirmed the presence of pericardial thickening and calcifications. The patient underwent beat-heart pericardial decortication. The anatomopathological examination of the surgical piece revealed Mycobacterium tuberculosis. The postoperative check-up after 6 months showed good clinical and echocardiographic evolution.

Constrictive pericarditis (CP) is a complex clinical syndrome in which an inflamed pericardium becomes fibrotic and non-compliant, ultimately reducing cardiac pump performance. Although we have known about CP for centuries, it remains a challenge to diagnose. Recent advances in cardiac imaging, along with an expanding armamentarium of treatment options, have improved the quality and precision of care for patients with CP. This article reviews important historical and contemporary perspectives on the pathophysiology of CP, as well as our approach to diagnosis and management. [Display omitted] • Loss of pericardial compliance and reserve volume are central to the pathophysiology of constrictive pericarditis. • Patient presentation, treatment, and prognosis are related to the extent of pericardial fibrosis. • Diagnosis may require integrating clinical data with cardiac imaging and invasive hemodynamics. • Transthoracic echocardiography remains the first-line imaging modality. • Cardiac magnetic resonance imaging and computed tomography can help confirm diagnosis and guide the next steps in management. [ABSTRACT FROM AUTHOR]

Abstract Background Pulmonary hypertension in young children can be due to a myriad of conditions. Few aetiologies of pulmonary hypertension are potentially reversible. An extensive workup for the cause of pulmonary hypertension is a must before attributing it to idiopathic pulmonary hypertension. We describe an uncommon aetiology of pulmonary hypertension in a young boy. Case presentation A 12-year-old child, with past history of tubercular pleural effusion, presented with dyspnoea on exertion and easy fatiguability for 2 years. He was evaluated elsewhere and was being treated as primary pulmonary hypertension with pulmonary vasodilators. The child was revaluated since the clinical features were not completely favouring the diagnosis. On detailed evaluation, a diagnosis of constrictive pericarditis was made. He was referred for pericardiectomy. Conclusions Constrictive pericarditis presenting with severe pulmonary hypertension without congestive symptoms is very rare. In patients presenting with pulmonary hypertension, always look for a reversible cause before labeling them as idiopathic PAH.

Background: Pulmonary hypertension in young children can be due to a myriad of conditions. Few aetiologies of pulmonary hypertension are potentially reversible. An extensive workup for the cause of pulmonary hypertension is a must before attributing it to idiopathic pulmonary hypertension. We describe an uncommon aetiology of pulmonary hypertension in a young boy. Case presentation: A 12-year-old child, with past history of tubercular pleural effusion, presented with dyspnoea on exertion and easy fatiguability for 2 years. He was evaluated elsewhere and was being treated as primary pulmonary hypertension with pulmonary vasodilators. The child was revaluated since the clinical features were not completely favouring the diagnosis. On detailed evaluation, a diagnosis of constrictive pericarditis was made. He was referred for pericardiectomy. Conclusions: Constrictive pericarditis presenting with severe pulmonary hypertension without congestive symptoms is very rare. In patients presenting with pulmonary hypertension, always look for a reversible cause before labeling them as idiopathic PAH. [ABSTRACT FROM AUTHOR]

Chronic constrictive pericarditis (CCP) is usually caused by the fibroinflammatory reaction of the visceral and parietal pericardium that encase the heart. The cause of CCP is various including tuberculosis, trauma, prior surgery, radiation, and malignancy. We examined the pericardiectomy specimen of a case of CCP in a 17-year-old boy. The histopathology of the pericardium revealed pericardial ossification bony remodeling and hematopoiesis within the intertrabecular marrow spaces. No granulomatous or neoplastic etiology was identified. Idiopathic pericardial ossification can cause CCP in pediatric patients. [ABSTRACT FROM AUTHOR]

Chronic constrictive pericarditis is a rare condition characterized by clinical signs of right heart failure, due to the symphysis of the two pericardial leaflets. Our study focused on a retrospective analysis of 43 CCP surgery observations collected over an 11-year period (2003–2013). The mean age of the patients was 32 years; 65% were male; exercise dyspnea (95%) was the most frequent sign. Two main etiologies were observed: tuberculosis 58% and idiopathic causes 42%. All of our patients received a subtotal pericardectomy per median sternotomy, of which 95% had no cardiopulmonary bypass. [ABSTRACT FROM AUTHOR]

Background Constrictive pericarditis (CP), also known as Pick's disease, is a sequela of chronic inflammation of the pericardium. Pericardial calcification is a common occurrence in CP; however, extensive egg-shell like calcification is rare. Our case, highlights, how a multi-modality imaging in a middle aged female helped to diagnose chronic constrictive pericarditis (CCP) with egg-shell like calcification encasing the heart. Case summary Middle aged female with features of right heart failure, was diagnosed as CP based on two-dimensional echocardiography and cardiac catheterization. Computed tomography (CT) scan chest showed extensive egg-shell like calcification encasing the heart, suggestive of calcific CP. Subsequently, she underwent pericardiectomy, through median sternotomy approach and is currently on follow-up with asymptomatic cardiac status. Discussion Extensive pericardial calcification encasing the heart like an egg-shell is rare in CCP. Likelihood of incomplete pericardial resection is high in calcific CP and hence a median sternotomy is preferred over anterolateral thoracotomy. A preoperative non-contrast CT scan defines the thickness, anatomic extent the calcification and its adherence to myocardium and surrounding structures. A reconstructed volume-rendered image delineates the extent of calcification precisely, thus determining the optimum surgical approach. A multi-modality imaging in CP, especially in calcific CP, is thus of paramount importance. [ABSTRACT FROM AUTHOR]

Chronic constrictive pericarditis is a rare condition characterized by clinical signs of right heart failure, due to the symphysis of the two pericardial leaflets. Our study focused on a retrospective analysis of 43 CCP surgery observations collected over an 11-year period (2003-2013). The mean age of the patients was 32 years; 65% were male; exercise dyspnea (95%) was the most frequent sign. Two main etiologies were observed: tuberculosis 58% and idiopathic causes 42%. All of our patients received a subtotal pericardectomy per median sternotomy, of which 95% had no cardiopulmonary bypass., Competing Interests: Déclaration de liens d'intérêts Les auteurs déclarent n'avoir aucun lien d'intérêt, (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Pericardial mesotheliomas are rare tumors which often present with features of constrictive pericarditis. We present clinical, imaging, histological, and immunohistochemical findings of three cases presenting with chronic constrictive pericarditis. Two of these cases were initially treated as tuberculous pericarditis. Histologically, all the three cases were of an epithelioid type and showed positivity for more than one mesothelial markers. Two patients had a fatal outcome, and one was lost to follow-up.

Objectives: This study was designed to prospectively investigate the effects of pericardiectomy via median sternotomy on intra- and postoperative hemodynamics by a new semi-invasive device (Flotrac/VigileoTM monitor) using arterial pressure waveform analysis. Patients and Methods: Thirty consecutive patients aged 15 to 55 years (mean+SD, 31.73 + 13.53 years), who had undergone total pericardiectomy via median sternotomy underwent serial hemodynamic evaluation. FlotracTM Sensor – derived stroke volume, stroke volume variation, systemic vascular resistance index (SVRI), cardiac index and right atrial pressure were measured just before and after pericardiectomy, at 12 hours, 24 hours, 48 hours, 72 hours and at discharge postoperatively. Results: Majority of patients (73.33%) exhibited statistically significant reduction of right atrial pressure and SVRI along with improvement in cardiac index and oxygen delivery in the immediate and late postoperative period. However, the stroke volume and stroke volume variation did not increase proportionately on completion of surgery. Patients with low cardiac output syndrome exhibited persistently high central venous pressure with reduced cardiac index and echocardiographically abnormal diastolic filling characteristics. Conclusions: We conclude that there is early normalization of hemodynamics following pericardiectomy via median sternotomy and the adequacy of pericardiectomy can be accurately assessed by the new semi-invasive arterial pressure waveform analysis device. Stroke volume variation is a non-predictor of fluid requirement during and after pericardiectomy.

We are reporting two cases of neck and arm major venous thrombosis in patients of posttubercular chronic constrictive pericarditis posted for pericardectomy. There was unanticipated difficulty in placement of Internal Jugular vein catheter and subsequent ultrasound revealed thrombosis in the major veins. It was not diagnosed in the preoperative period. This report raises this major complication and highlights the use of ultrasound in such scenarios.

Chronic Pericarditis is inflammation that begins gradually, is long lasting and results in fluid accumulation in the pericardial space or thickening of the pericardium. The etiology is unknown but may be cancer, TB or hypothyroidism. Arrhythmias are common and seen in almost half the patients. The commonest arrhythmia is atrial fibrillation. Symptoms and signs are related to increased right atrial pressure and physical findings include elevated JVP and pericardial knock. Non surgical therapy consists mainly of no salt. Surgery cures about 85% of patients, however 5-15% of patients will die. Chronic effusive pericarditis occurs when there is persistent restriction of the visceral pericardium after pericardiocentesis. [ABSTRACT FROM AUTHOR]

Objectives: This study was designed to prospectively investigate the effects of pericardiectomy via median sternotomy on intra- and postoperative hemodynamics by a new semi-invasive device (Flotrac/VigileoTM monitor) using arterial pressure waveform analysis. Patients and Methods: Thirty consecutive patients aged 15 to 55 years (mean+SD, 31.73 + 13.53 years), who had undergone total pericardiectomy via median sternotomy underwent serial hemodynamic evaluation. FlotracTM Sensor - derived stroke volume, stroke volume variation, systemic vascular resistance index (SVRI), cardiac index and right atrial pressure were measured just before and after pericardiectomy, at 12 hours, 24 hours, 48 hours, 72 hours and at discharge postoperatively. Results: Majority of patients (73.33%) exhibited statistically significant reduction of right atrial pressure and SVRI along with improvement in cardiac index and oxygen delivery in the immediate and late postoperative period. However, the stroke volume and stroke volume variation did not increase proportionately on completion of surgery. Patients with low cardiac output syndrome exhibited persistently high central venous pressure with reduced cardiac index and echocardiographically abnormal diastolic filling characteristics. Conclusions: We conclude that there is early normalization of hemodynamics following pericardiectomy via median sternotomy and the adequacy of pericardiectomy can be accurately assessed by the new semi-invasive arterial pressure waveform analysis device. Stroke volume variation is a non-predictor of fluid requirement during and after pericardiectomy. [ABSTRACT FROM AUTHOR]

Objetivo: describir evolución de casos tratados por pericarditis constrictiva. Métodos: se presentan 5 casos tratados por orden cronológico por pericarditis constrictiva en los hospitales "Amalia Simoni" de Camagüey (4) y "Martín Chang Puga" de Nuevitas (1), en 5 años (2004-2008), cuya indicación quirúrgica principal fue la evidencia clínica de taponamiento cardiaco. Resultados: la edad promedio fue 49 años (rango 36-68), 4 pacientes del sexo masculino, en 4 el derrame fue serohemático y otro purulento. En un paciente apareció el corazón en coraza con calcificaciones. La etiología fue postraumática, infección aguda y metástasis pericárdica en un caso cada una. En 2 pacientes no se confirmó la tuberculosis pericárdica extrapulmonar, aunque pudo corresponderse. El acceso al tórax mayormente fue por toracotomía anterior izquierda, y el proceder fue la pericardiectomía extensa, previa punción pericárdica. De los 5 casos, 3 pacientes egresaron vivos y 2 fallecidos. Conclusiones: los pacientes con pericarditis constrictiva, derrame y signos de taponamiento cardiaco deben ser tratados con pericardiocentesis, y la pericardiectomía extensa, cuando esté indicada. Se considera una buena opción terapéutica.Objective: to describe the evolution of the cases treated by constrictive pericarditis. Methods: a retrospective study was performed in five cases treated by chronological order due to constrictive pericarditis in the hospitals "Amalia Simoni" of Camagüey province (4) and "Martin Chang Puga" of Nuevitas municipality (1) in 5 years (2004-2008) whose main surgical indication was the clinical evidence of cardiac tamponage. Results: mean age was of 49 years (range 36-68), four male patients in four of the leakage was serohematinic and another purulent type. In a patient there was a barrier heart with calcifications. Etiology was post-traumatic, acute infection and pericardial metastasis in a case each. In two patients extrapulmonary pericardial tuberculosis was not confirmed, although it could correspond. The thorax approach was mainly by left anterior thoracotomy and the procedure was an extensive pericardiectomy, previous pericardial puncture. From 5 cases, three patients were discharged alive and two dyed. Conclusions: patients presenting with constrictive pericarditis, leakage and signs of cardiac tamponage must to be treated with pericardiocentesis and the extensive pericardiectomy, when be prescribed. This is a good therapeutic option.

Objective: To investigate the effect of pericardiectomy on the level of atrial natriuretic peptide (ANP) and endothelin (ET) in elderly patients with chronic constrictive pericarditis. Methods: 66 cases of chronic constrictive pericarditis from our hospital were selected and randomly divided into the control group and the patients in experiment group with 33 cases in each group. Two groups were given corresponding treatment, the patients in control group were given corresponding drugs to increase the heart's contractility, and some vasodilator drugs, and the patients in experimental group underwent pericardiectomy. After the end of treatment, the level of ANF, ET and blood pressure and clinical therapeutic effect were detected and compared. Results: Compared with before treatment, after treatment the level of ANF ET, diastolic pressure and pulse pressure were decreased in two groups, and the systolic blood pressure was elevated (P<0.05); compared with the control group, the level of ANF, ET, diastolic pressure and pulse pressure was lower in experimental group, and the systolic blood pressure level was higher (P<0.05). After treatment, the total efficiency was higher in the experimental group than that of control group (P<0.05). Conclusion: The pericardiectomy can reduce the level of ANF ET, diastolic blood pressure and pulse pressure and elevate systolic blood pressure level, and has good clinical curative effect in the treatment of chronic constrictive pericarditis. [ABSTRACT FROM AUTHOR]

We are reporting two cases of neck and arm major venous thrombosis in patients of posttubercular chronic constrictive pericarditis posted for pericardectomy. There was unanticipated difficulty in placement of Internal Jugular vein catheter and subsequent ultrasound revealed thrombosis in the major veins. It was not diagnosed in the preoperative period. This report raises this major complication and highlights the use of ultrasound in such scenarios. [ABSTRACT FROM AUTHOR]

In medical schools worldwide, the traditional clinical approach is based on the law of parsimony. Physicians in daily clinical practice attempt to fulfill this very simplified yet complex concept of unifying the diagnosis in a given clinical scenario. However, failures are not uncommon. This report presents a case of tetralogy of Fallot who presented with heart failure at young age of 18 months. This is the first description of coexisting tubercular chronic constrictive pericarditis and tetralogy of Fallot. This case is reported for its unique association of two relatively uncommon clinical entities. The logistic dictum of Hickam in similar circumstances is discussed. [ABSTRACT FROM AUTHOR]

Chronic constrictive pericarditis (CCP) is a clinical syndrome caused by compression of the heart due to a thickened or rigid pericardium. In the affluent West, the majority of cases of CCP are neither tuberculous nor calcific. In an American cohort undergoing pericardectomy for the condition, only 27% had calcification and under 10% had TB []. As a result, pericardial calcification (PC) as a marker of CCP has become neglected. We present a 48-year-old male admitted with atrial flutter, acute chest infection and signs of right heart congestion. PC was documented one year previously on a non-contrast CT chest. On this occasion, cardiac catheterisation confirmed hemodynamically significant CCP and cardiac magnetic resonance (cMR) study showed contiguous mass lesions in the pericardium, compression of the right ventricle, enlargement of the right atrium, hepatic enlargement and a pneumonic process in the left lung. He was commenced on antibiotics and anti-tuberculous therapy with a diagnosis of bacterial super-infection of tuberculous CCP. This was confirmed at pericardectomy along with an infected fistula into the left lung. Any finding of PC should be followed up with a thorough haemodynamic and anatomical assessment using any of a wide range of non-invasive imaging modalities. [ABSTRACT FROM AUTHOR]

Chronic constrictive pericarditis (CCP) is the most common pericardial pathology. CCP complicating with intracardiac thrombus is a rare entity, the detection of thrombus preoperatively is life-saving in avoiding the risk of pulmonary thromboembolism during anterior pericardiectomy. Transesophageal echocardiography has been shown to have better sensitivity in detecting atrial thrombus than transthoracic echocardiography. Surgical removal of right atrial thrombus under cardiopulmonary bypass should be considered. [ABSTRACT FROM AUTHOR]