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Occult constrictive pericardial disease. Diagnosis by rapid volume expansion and correction by pericardiectomy
Insights
Occult constrictive pericardial disease (OCPD) is a hidden heart condition diagnosed by its response to fluid infusion. Pericardiectomy surgery effectively relieved symptoms in patients with OCPD.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Pericardial disease can be present without obvious symptoms.
- Occult constrictive pericardial disease (OCPD) presents with normal baseline hemodynamics.
Purpose of the Study:
- To describe the diagnostic method for OCPD.
- To recommend pericardiectomy for symptomatic OCPD management.
Main Methods:
- Diagnosis involves assessing hemodynamic response to rapid saline infusion.
- Key diagnostic criteria include specific pressure pulse morphology and diastolic equilibration.
- Nineteen patients with OCPD were identified over five years.
Main Results:
- Patients presented with unexplained fatigue, dyspnea, and chest pain.
- Eleven patients underwent pericardiectomy with dramatic symptomatic improvement.
- Post-surgery recatheterization showed normalization of hemodynamics in five patients.
Conclusions:
- OCPD is a recognizable condition with a specific diagnostic protocol.
- Pericardiectomy is an effective treatment for disabling OCPD symptoms.
Abstract:
Significant pericardial disease can exist without overt manifestations. Occult constrictive pericardial disease (OCPD) is identified by normal baseline hemodynamics and normal left ventricular systolic function with a characteristic response to rapid volume infusion. Following the intravenous administration of 1000 ml of normal saline over six to eight minutes, striking elevations of filling pressures are seen; however, diagnosis depends specifically upon a) the development of typical pressure pulse morphology of constriction, b) loss or reversal or respiratory variation of right atrial pressure, and c) precise diastolic equilibration of intracardiac pressures. Nineteen patients with OCPD have been identified in a five year period. Unexplained fatigue, dyspnea and chest pain was the uniform pattern of presentation. Eleven have undergone pericardiectomy resulting in a dramatic symptomatic improvement in all. Each demonstrated gross and/or microscopic evidence of pericardial disease. Recatheterization with volume infusion in five patients following pericardiectomy has revealed return to normal or near normal hemodynamics. This study describes the method for diagnosis of OCPD and recommends pericardiectomy for the management of disabling symptoms.