Chronic Cardiac Compression (Chronic Constrictive Pericarditis)

Abstract

Sixty-one patients with chronic cardliaic compression were stu(lie(l critically, the largest series in the literature. All patients had pericardiectomy perfoilie(l. The operative mortality was 18 pel cent. Satisfactory result was obtainedl 72.1 pei cent of the patients operate(l. Tuberculosis wa.1s the ca.use in 28.2 pei cent. In most of the remaining cases the etiology was obscure. The symptomlls, physical signs, and laboratory examinations are reported. The physiologic stuldies after operation (lemonstrato improved cardiac filling and emptving.The imllortance of diagnosis and the desirability of pericar(liectomy are stressed. With antiliotic therapy there is less risk in operating patients with active infection and the compression syndlrome.IN THE past 20 years the many cases of chronic compression operatecl at IUniversity Hospitals of Cleveland offered an opportunity for careful study. This report is based upon 61 operative cases from the service of Dr. C. S. Beck, with a study of pre-and postoperative observations. To our knowledge, this is the largest series e-ver reported.Chronic cardiac compression occurs as the result of a contracting pericar(lial scar which encroaches upon the diastolic filling and the systolic emptying of the heart, thereby reducing output. Usually the entire pericardium is converti into a compressing, nondistensible sac. Occasionally a localized fibrous band constricts the inflow or outflow tract of either ventricle. This is the basic pathologic and physiologic disturbance causing the various clinical and laboratory findings.Excellent historical reviews have been written by White

Chronic Constrictive Pericarditis Combined with Hypoproteinaemia

“…With one exception they were more than 20 years old when they were inwestigated. These figures do not differ very much from those given by Chambliss et al (1951), who found an average of 3 46 g. albumin per 100 ml. of serum in 39 patients, most of them adults.…”

“…the third and fourth decades of life (PauL Castleman and Chambliss, Jaruszewski, Brofman, Martin and Feil, 1951), but is rare under the age of 10. Rothstein (1934) collected 34 cases from the literature in children up to 15 years old, who had been operated on, but only 12 were younger than 10.…”

“…Discussi The syndrome of constrictive pericarditis is rare, especially in children, although dense, scar-like adhesions of the pericardium are found in 2 to 4% of all necropsies (Moschcowitz, 1953). Large surveys on diagnosis and treatment have been published during recent years by Holman andWillett (1949), Paul et al (1948), White, Alexander, Churchill andSweet (1948) andChambliss et al (1951). No special attention has been paid to differerces in the syndrome at various ages, but McKusick (1952) mentions the possibility that the association of constrictive pericarditis with hypoproteinaemia might be a special feature in children.…”

Non-tuberculous Constrictive Pericarditis

“…, 1968, 1, 290-292 Constrictive pericarditis often occurs without a known cause. Out-of 181 cases collected from the literature (Chambliss et al, 1951;Kaltman et al, 1953;Hansen and Hansen, 1959;Gimlette, 1959) only 46 were shown to be due to tuberculosis; in 103 no cause could be found.…”

Prognosis after Operation for Constrictive Pericarditis

“…The diagnostic features of the disease have been amply described by White (1935), Chambliss et al (1951, and Wood (1956Wood ( , 1961 and require no further elaboration. Our experience confirms that in cases where the acute illness with effusion is witnessed the earliest clue to constriction is the diminution of the cardiac shadow on x-ray films (as the fluid is absorbed) without a concurrent fall in venous pressure.…”