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Characteristics of coronary flow velocity in constrictive pericarditis
H Fujinaga1, T Wakatsuki, K Sakabe
1Second Department of Internal Medicine, School of Medicine, University of Tokushima, Japan. fujinaga@clin.med.tokushima-u.ac.jp
Insights
Constrictive pericarditis can cause a characteristic dip and plateau pattern in cardiac pressures and coronary flow velocity. Surgical removal of the pericardium resolved the pressure pattern but not the coronary flow abnormality.
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Constrictive pericarditis is a serious condition affecting the heart's ability to function properly.
- Early diagnosis and understanding of its hemodynamic effects are crucial for effective treatment.
Observation:
- A patient with constrictive pericarditis exhibited a distinct "dip and plateau" pattern in both ventricular pressure curves.
- Coronary flow velocity measurements using Doppler guidewire also revealed a similar "dip and plateau" configuration during early diastole.
Findings:
- Cardiac catheterization post-pericardiectomy showed resolution of the ventricular pressure "dip and plateau" pattern.
- However, the early diastolic dip in coronary flow velocity persisted, suggesting myocardial involvement.
Implications:
- This case highlights the utility of Doppler guidewire in assessing coronary flow dynamics in constrictive pericarditis.
- Persistent coronary flow abnormalities post-surgery may indicate underlying myocardial infiltration, impacting long-term prognosis.
Abstract:
A 50-yr-old man developed constrictive pericarditis following an episode of acute pericarditis. Cardiac catheterization revealed a typical early diastolic dip and plateau configuration in both the right and left ventricular pressure curves. The coronary flow velocity pattern determined using an intracoronary Doppler guidewire showed an abrupt decrease in peak velocity at early diastole and followed by plateau until late diastole, the so-called dip and plateau configuration. After a successful pericardiectomy, cardiac catheterization no longer showed the dip and plateau configuration, but the early diastolic dip in the coronary flow velocity persisted probably because of infiltration of the organic involvement into the myocardium.