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Restrictive pericarditis
M Y Henein1, R D Rakhit, M N Sheppard
1Cardiac Department, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
Insights
Pericardial thickening after cardiac surgery can cause severe venous congestion. Early diagnosis and treatment, such as pericardiectomy, are crucial for managing this rare complication.
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Pericardial thickening is an infrequent complication following cardiac surgery.
- Investigating pericardial thickening as a cause of severe postoperative venous congestion.
Observation:
- Two male patients with coronary artery disease underwent coronary artery bypass grafting.
- Diagnostic methods included magnetic resonance imaging (MRI), Doppler echocardiography, and cardiac catheterization.
Findings:
- Both patients presented with elevated venous pressure and evidence of restrictive physiology.
- MRI revealed pericardial thickening, and cardiac catheterization showed diastolic pressure equalization.
- Pericardiectomy confirmed thickened, fibrotic pericardium and epicardium.
Implications:
- Restrictive pericarditis, distinct from myocardial disease, requires specific diagnostic and therapeutic approaches.
- Standard investigations can confirm the diagnosis, though thoracotomy may be necessary.
- Recognizing restrictive pericarditis is vital for appropriate patient management post-cardiac surgery.
Background:
Pericardial thickening is an uncommon complication of cardiac surgery.
Objectives:
To study pericardial thickening as the cause of severe postoperative venous congestion.
Subjects:
Two men, one with severe aortic stenosis and single coronary artery disease, and one with coronary artery disease after an old inferior infarction. Both had coronary artery bypass grafting surgery.
Methods:
Magnetic resonance imaging (MRI), Doppler echocardiography, and cardiac catheterisation.
Results:
Venous pressure was raised in both patients. MRI showed mildly thickened pericardium, and cardiac catheterisation indicated diastolic equalization of pressures in the four chambers. Jugular venous pulse showed a dominant "Y" descent coinciding with early diastolic flow in the superior vena cava, and mitral and tricuspid Doppler forward flow proved restrictive physiology. The clinical background suggested pericardial disease so both patients had pericardiectomy. This proved the pericardium to be thickened; the extent of fibrosis also involved the epicardium.
Conclusions:
Although rare, restrictive pericarditis (restrictive ventricular physiology resulting from pericardial disease) should be considered to be a separate diagnostic entity because its pathological basis and treatment are different from intrinsic myocardial disease. This diagnosis may be confirmed by standard investigational techniques or may require diagnostic thoracotomy.