Related Experiment Videos
[Chronic constrictive pericarditis apropos of 3 cases disclosed by refractory cardiac failure]
J P Quéré1, C Tribouilloy, G Drobinsky
1Service de cardiologie B, hôpital Sud, Amiens.
Insights
Diagnosing constrictive pericarditis can be challenging, often requiring advanced imaging like Doppler echocardiography. Early and accurate diagnosis is key for effective treatment and surgical intervention, such as pericardectomy.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Chronic constrictive pericarditis presents diagnostic challenges, often with atypical presentations and delayed diagnosis.
- Effective diagnostic strategies are crucial for timely intervention in constrictive pericarditis.
Observation:
- Three clinical cases highlight the difficulties in diagnosing constrictive pericarditis, with diagnosis delayed by over a year.
- Chest X-rays may not show pericardial calcification in cardiac failure; Doppler echocardiography is the primary diagnostic tool.
Findings:
- Doppler echocardiography differentiates constrictive pericarditis from restrictive cardiomyopathy by assessing pericardial thickening, septal motion, and respiratory variations in ventricular dimensions.
- Catheterization confirms adiastole and can suggest pericardial etiology with mild pulmonary artery pressure increases.
- Advanced imaging like MRI can detect pericardial thickening, while endomyocardial biopsy rules out fibrosis in ambiguous cases.
Implications:
- Accurate diagnosis via echocardiography and other modalities is essential for appropriate patient management.
- Pericardectomy is indicated when constrictive pericarditis is confirmed and other conditions are ruled out.
- Improved diagnostic pathways can lead to earlier treatment and better outcomes for patients with constrictive pericarditis.
Abstract:
Chronic constrictive pericarditis is a difficult diagnosis and may present atypically. The authors report three clinical cases and review the diagnostic strategy of constrictive pericarditis. In these three patients, the diagnosis was finally made after one or more years of symptomatic disease and after several diagnostic work ups and ineffective treatments. In cardiac failure, pericardial calcification is often not observed on chest X-ray and Doppler echocardiography is usually the diagnostic investigation. Adiastole presents with dilatation of the vena cava and atria, contrasting with normal ventricles without major valvular disease. Doppler echocardiography enables distinction of constrictive pericarditis from restrictive cardiomyopathy: normal myocardium, thickened pericardium, specific septal motion, inspiratory increase in right ventricular dimensions, premature opening of the pulmonary valve, important variations in ventricular filling with respiration, expiratory diastolic reflux in the hepatic veins. Catheterisation confirms adiastole and may suggest a pericardial aetiology in characteristic cases, associated with only mild increases in pulmonary artery pressure. If need be, the pericardial thickening > 4 mm may be observed with magnetic nuclear resonance imaging and, when a doubt remains with respect to the diagnosis of cardiomyopathy, the absence of fibrosis on endomyocardial biopsy provides the diagnosis and indication for curative surgery: pericardectomy.