Role of echocardiography in detecting the anatomic and physiologic abnormalities of constrictive pericarditis

Constrictive pericarditis (CP) is associated with thickening of the pericardium (P), rapid filling of the ventricles, and a steep rise of early diastolic pressure in the right and left ventricles. We investigated the frequency with which echocardiography detects the characteristic anatomic and physiologic abnormalities of CP. M-mode echocardiography was performed in 10 patients with CP. All patients had evidence of pericardial thickening. Eight patients had motion of the P parallel to the epicardium with an echo-free space between the two structures. Two patients had a small pericardial and left pleural effusion sandwiching the P which measured 8 mm, and 14 mm respectively. Premature pulmonic valve opening indicating a high right ventricular early diastolic pressure which exceeded the pulmonary artery diastolic pressure was present in all 5 patients in whom the pulmonic valve was recordable. A notch on the septum in early diastole was seen in 6 patients. Sharp posterior motion of the left ventricular posterior wall in early diastole followed by a flat segment was noted in 7 patients. Motion of the posterior wall of the aortic root (PWAo) in diastole has been shown to indicate left atrial volume changes or reflect left ventricular filling. An index of early diastolic left ventricular filling derived from the motion of the posterior wall of the aortic root, indicated abnormally rapid early diastolic filling in all 8 patients in whom this was measured. We conclude: 1) The anatomic and physiologic abnormalities in CP are commonly reflected on the echocardiogram, and 2) echocardiography should be useful in evaluation of patients suspected of having CP.