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Constrictive pericarditis in 26 patients with histologically normal pericardial thickness
Deepak R Talreja1, William D Edwards, Gordon K Danielson
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Circulation
|October 1, 2003
Summary
Constrictive pericarditis can occur with normal pericardial thickness, even with abnormal microscopic findings. Pericardiectomy remains effective for symptom relief, regardless of pericardial thickness.
Area of Science:
- Cardiology
- Pathology
- Thoracic Surgery
Background:
- Constrictive pericarditis diagnosis traditionally relies on increased pericardial thickness.
- Normal pericardial thickness in constrictive pericarditis has been observed noninvasively, but clinicopathological details were lacking.
Purpose of the Study:
- To investigate the clinicopathological correlates of constrictive pericarditis in patients with normal pericardial thickness.
Main Methods:
- Retrospective review of 143 patients undergoing pericardiectomy for constrictive pericarditis (1993-1999).
- Analysis of baseline characteristics, operative data, and histopathological specimens.
- Categorization into normal (< or =2 mm) and thickened (>2 mm) pericardial groups.
Main Results:
- 18% (26/143) of patients had normal pericardial thickness.
- Common causes in the normal-thickness group included prior surgery, irradiation, infarction, and idiopathic disease.
- Histopathology revealed mild, focal abnormalities in all normal-thickness cases; pericardiectomy outcomes were similar between groups.
Conclusions:
- Pericardial thickness is not always increased in constrictive pericarditis, despite focal histopathological abnormalities.
- Pericardiectomy should be considered for heart failure patients with suspected constriction, irrespective of noninvasive imaging showing normal pericardial thickness.
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