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Constrictive chronic pericarditis in children
S M Gomes Ferreira1, A Gomes Ferreira, A do Nascimento Morais
1Fundação Luiz Décourt, Serviço de Cardiologia, Federal do Pará, Brazil. ferreira@amazon.com.br
Insights
Constrictive pericarditis, a rare pediatric condition, can cause severe heart constriction even without prior pericardial disease. Differentiating it from restrictive cardiomyopathy is crucial for proper treatment and prognosis.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Imaging
- Cardiac Physiology
Background:
- Constrictive pericarditis is uncommon in children.
- Pericardial thickening can lead to severe constrictive physiology.
- Restrictive cardiomyopathy may present with similar hemodynamic features.
Observation:
- Two pediatric patients presented with refractory ascites and elevated systemic venous pressure.
- Cardiac catheterization revealed diastolic pressure equalization across all four chambers.
- Doppler echocardiography showed a restrictive mitral inflow pattern.
Findings:
- Magnetic resonance imaging did not detect pericardial thickening in either patient.
- Cardiac catheterization findings were consistent with constrictive pericarditis, despite lack of suggestive clinical history.
- One patient also exhibited hemodynamic features of restrictive cardiomyopathy.
Implications:
- A high index of suspicion is necessary to diagnose constrictive pericarditis in children, especially when no preceding pericardial disease is evident.
- Co-existence of constrictive pericarditis and restrictive cardiomyopathy is possible.
- Accurate differentiation is vital for appropriate management and improved patient outcomes.
Abstract:
Constrictive pericarditis is a uncommom disease in children. We have now encountered pericardial thickening as the cause of severe constrictive physiology in two patients, one also having haemodynamic features of restrictive cardiomyopathy. Both patients, who had refractory ascites and evidence of increased systemic venous pressure, underwent Doppler echocardiography, cardiac catheterisation, and magnetic resonance imaging. Resonance imaging failed to show any thickning of the pericardium, but cardiac catheterisation revealed diastolic equalisation of pressures in all four chambers, with only mild elevation of pulmonary pressure in the first patient, but nearly equalisation of diastolic pressure, and a very high pulmonary arterial pressure with a difference of 7 mm Hg between the end diastolic pressures in the two ventricles in the second patient. Doppler revealed a restrictive pattern of mitral inflow, with high E and small A velocities and a short deceleration time. The clinical background did not suggest pericardial disease in either of the patients. We conclude that a careful search is needed to uncover constrictive pericarditis when there is no previous disease which may suggest late pericardial constriction. The haemodynamic features of restrictive cardiomyopathy can co-exist with pericardial restriction, and differentiation between the two entities is critical in view of the diverse management and prognosis of the two conditions.