[Echocardiography in the evaluation of constrictive pericarditis. 25 cases]

Twenty five patients with constrictive pericarditis underwent cross-sectional and M-mode echocardiography before pericardectomy. The numerical data were compared with those in thirty healthy subjects. The various parameters noted regarding the left cavities were as follows: --The presence of a pericardial detachment which may sometimes be quite large (more than 10 mm in 6 cases); the degree of parallelism of the pericardial membranes in systole, which is all the less maintained as the detachment is severe. --The increase in size of the right ventricle and decrease of the left, with p less than 0.001 in both cases. --The absence of posterior motion of the left side of the septum in systole in 22 cases, followed by a sudden posterior displacement during the rapid filling stage, after which there is virtually no motion until the end of diastole. --The presence at the level of the posterior wall of a so-called slow filling slope, which is smaller (1.9 +/- 1.5 mm/s) than in the normal subject (p less than 0.001). --A change in left ventricular endocavitary diameter variations, which results from the two previous findings. The tracings thus show the compliance disorder with a very steep rapid filling slope and a plateau during the slow filling stage. --Finally the changes in mitral kinetics involving an earlier (p less than 0.001) and lower (p less than 0.001) F point than in the control series and on the other hand an larger E wave, sometimes forming a summation with A wave in sinus rhythm and a false A wave in atrial fibrillation. We think this type of motion is due to the disturbances in the two mechanisms (recirculation, breaking of a jet) which in physiological conditions seem to combine to chose the mitral valve at point F and account for the valve position in mid-diastole.