Presentation pattern and management of effusive-constrictive pericarditis in Ibadan

Abstract

BackgroundEffusive–constrictive pericarditis is a syndrome in which constriction by the visceral pericardium occurs in the presence of a dense effusion in a free pericardial space. Treatment of this disease is problematic because pericardiocentesis does not relieve the impaired filling of the heart and surgical removal of the visceral pericardium is challenging. We sought to provide further information by addressing the evolution and clinico-pathological pattern, and optimal surgical management of this disease.MethodsWe conducted a prospective review of a consecutive series of five patients managed in the cardiothoracic surgery unit of University College Hospital, Ibadan, in the previous year, along with a general overview of other cases managed over a seven-year period. This was followed by an extensive literature review with a special focus on Africa.ResultsThe diagnosis of effusive–constrictive pericarditis was established on the basis of clinical findings of features of pericardial disease with evidence of pericardial effusion, and echocardiographic finding of constrictive physiology with or without radiological evidence of pericardial calcification. A review of our surgical records over the previous seven years revealed a prevalence of 13% among patients with pericardial disease of any type (11/86), 22% of patients presenting with effusive pericardial disease (11/50) and 35% who had had pericardiectomy for constrictive pericarditis (11/31). All five cases in this series were confirmed by a clinical scenario of non-resolving cardiac impairment despite adequate open pericardial drainage. They all improved following pericardiectomy.ConclusionEffusive–constrictive pericarditis as a subset of pericardial disease deserves closer study and individualisation of treatment. Evaluating patients suspected of having the disease affords clinicians the opportunity to integrate clinical features and non-invasive investigations with or without findings at pericardiostomy, to derive a management plan tailored to each patient. The limited number of patients in this series called for caution in generalisation. Hence our aim was to increase the sensitivity of others to issues raised and help spur on further collaborative studies to lay down guidelines with an African perspective.

Prevalence, Hemodynamics, and Cytokine Profile of Effusive-Constrictive Pericarditis in Patients with Tuberculous Pericardial Effusion

“…ECP is recognized as an important manifestation of pericardial tuberculosis [5], a disease that is associated with high morbidity and mortality [6,7]. There are, however, no studies of tuberculous ECP that have used combined pericardiocentesis and cardiac catheterization, the ‘gold standard’ for the diagnosis of effusive-constrictive disease [8].…”

Pericarditis Constrictiva: Reporte De Un Caso en El Hospital “Carlos Andrade Marín”.

“…Así, en 1669 Richard Lower describe fisiológicamente a la pericarditis constrictiva en un paciente con disnea y pulso intermitente. Históricamente, el epónimo "Enfermedad de Pick" fue dado a un paciente con esta patología que presentaba ascitis y hepatomegalia, lo cual implica que estos pacientes pueden ser erró-neamente diagnosticados con una enfermedad crónica del hígado [7][8][9]. Las características clínico-histopatológicas fueron descritas por Norman Chevers en 1842, quien declaró que "el material que se deposita alrededor del corazón no permite un adecuado llenado cardíaco por lo que el paciente llega a ser incapaz de realizar esfuerzo muscular y siempre ser portador de hidropesía o efusiones serosas" [10].…”

Effusive-constrictive tuberculous pericarditis in the setting of penetrating abdominal trauma

“…The gold standard to diagnose ECP is the measurement of intrapericardial and intracardiac pressures before and after pericardiocentesis 3. ECP is believed to be a manifestation of pericardial TB4 as it progresses to a fibrous constrictive pericarditis 4 5. Previous literature has described the incidence of ECP in the setting of tuberculous pericarditis to range from 3% to 14% 6.…”