Pressure Curves from the Right Auricle and the Right Ventricle in Chronic Constrictive Pericarditis

Hansen, Ann‐Brit Eg; Eskildsen, P; Gøtzsche, H

doi:10.1161/01.cir.3.6.881

Cited by 116 publications

(14 citation statements)

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“…Constrictive pericarditis was diagnosed by chest roentgenography (calcified pericardium), computed tomography scan (thickened pericardium and/or pleural effusion), 7 and confirmed by cardiac catheterization (elevated end-diastolic pressure and classic "square root sign" of right ventricular pressure tracing). 8,9 The etiological factors evaluated included underlying diseases, microbiological culture results, and histopathological findings. Tubercular pericarditis was diagnosed if the histopathological section of pericardium showed the granulomatous changes of Tb.…”

Section: Methodsmentioning

confidence: 99%

Clinical Characteristics and Treatment of Constrictive Pericarditis in Taiwan

Chen

Lai

2005

Circ J

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onstrictive pericarditis, an uncommon disease, is a chronic fibrous thickening of the pericardium that prevents the normal diastolic filling of the heart. Surgery is the only satisfactory treatment. Many factors associated with the development of constrictive pericarditis have been identified, such as infection, post heart surgery, post mediastinal irradiation, but in Western countries the spectrum of etiology has shifted from infection, especially Mycobacterium tuberculosis (Tb), to post heart surgery, although idiopathic causes still predominate. [1][2][3][4] In endemic areas, however, Tb remains the most common cause of constrictive pericarditis. 5,6 Thirteen years experience of constrictive pericarditis patients who underwent total pericardiectomy in a university hospital located in a rural area of Taiwan were reviewed and the clinical characteristics, especially the etiological spectrum, and operative approach were analyzed. MethodsWe retrospectively analyzed the characteristics of 23 patients (19 males, 4 females, age range 25-65 years) who underwent total pericardiectomy for constrictive pericarditis between January 1990 and December 2003. Constrictive pericarditis was diagnosed by chest roentgenography (calcified pericardium), computed tomography scan (thickened pericardium and/or pleural effusion), 7 and confirmed by cardiac catheterization (elevated end-diastolic pressure and classic "square root sign" of right ventricular pressure tracing). 8,9 The etiological factors evaluated included underlying diseases, microbiological culture results, and histopathological findings. Tubercular pericarditis was diagnosed if the histopathological section of pericardium showed the granulomatous changes of Tb. Table 1 shows the clinical characteristics of the study group prior to operation. The most common symptoms were exertional dyspnea (96%), jugular vein distension (96%), hepatomegaly (70%), general fatigue (65%), peripheral edema (65%), and ascites (52%). Pathogens isolated in 11 patients (48%) were Tb in 8 patients (35%) and streptococcus in 2 patients (9%); 1 patient had strongyloidiasis Results Clinical Characteristics and Treatment of Constrictive Pericarditis in TaiwanRobert Fu-Chean Chen, MD; Cha-Po Lai, MD* Background Constrictive pericarditis is an uncommon disease that prevents the normal diastolic filling of the heart and pericardiectomy is the only satisfactory treatment. Methods and ResultsThe clinical characteristics and treatment of patients who underwent pericardiectomy for constrictive pericarditis (n=23) were reviewed. Surgery was performed via left anterolateral thoracotomy plus transsternal extension in 3 patients, and median sternotomy in 20 patients. There were 2 deaths, resulting in an overall mortality rate of 8.7%. Of the 23 patients, 8 had Mycobacterium tuberculosis (Tb) infection, 2 had streptococcus infection, 1 had strongyloidiasis (Strongyloides stercoralis) and 1 developed the condition after a myocardial infarction; 2 patients underwent pericardial substitute insertion as post-hea...

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Section: Methodsmentioning

confidence: 99%

Clinical Characteristics and Treatment of Constrictive Pericarditis in Taiwan

Chen

Lai

2005

Circ J

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“…The classic studies of Wiggers4-6 have defined the various phases of the cardiac cycle, as well as the pressure relationships between the left atrium, left ventricle, and aorta, both in '9' 20 Human left ventricular pressures have been obtained by needle puncture at operation, [21][22][23] by puncture of the chest wall,24 and by catheterization of the left ventricle through a needle introduced into the left atrium through the chest wsall12 or through the left main bronchus. 26 Pressures in the human aorta have been measured by retrograde arterial catheterizationl7-0 by puncture of the chest,3" by needle puncture at the operating …”

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The Hemodynamics of the Left Side of the Heart as Studied by Simultaneous Left Atrial, Left Ventricular, and Aortic Pressures; Particular Reference to Mitral Stenosis

et al. 1955

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At operation the hemodynamics of the left side of the heart were studied in six patients without mitral stenosis, and in eight patients with mitral stenosis, by means of simultaneous needle puncture of the left atrium, left ventricle, and aorta. This technic permits analysis of the various phases of the cardiac cycale in normal subjects and in patients with mitral stenosis. The fundamental hemo-(lynamic expression of mitral stenosis is the presence of an elevated left atrioventricular filling pressure gradient, which ranged from 4 to 20 mm.Hg, and after valvulotomy fell in relation to the adequacy of the procedure.O UR knowledge of the human cardiac cycle has been retarded by the inability to study completely the hemodynamics of the left side of the heart. The technique of venous catheterization, which has contributed so much to an analysis of events in the right side of the heart of man1-3 does not permit the direct study of the left heart chambers except in isolated instances of congenital communications between the right and left cavities.Previous investigation of the left side of the circulation has been carried out primarily through animal experimentation.

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“…Cardiac catheterisation may reveal equalisation of diastolic chamber pressures and the ‘square root sign’ (figure 2) which is a manifestation of the ‘dip-and-plateau’ phenomenon described,21 and relative changes in left and right ventricular pressures with inspiration can help distinguish CP from severe valvular disease 22. While cardiac catheterisation is the gold standard for assessing the haemodynamics of CP, cardiac MRI is an extremely useful non-invasive modality 23 24.…”

Section: Discussionmentioning

confidence: 99%