HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Walsh, T. J. Articles by Bulkley, B. H. Search for Related Content PubMed PubMed Citation Articles by Walsh, T. J. Articles by Bulkley, B. H.

The Journal of Thoracic and Cardiovascular Surgery, Vol 83, 126-132, Copyright © 1982 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Constrictive epicarditis as a cause of delayed or absent response to pericardiectomy: a clinicopathological study

TJ Walsh, KL Baughman, TJ Gardner and BH Bulkley

It is widely held that constrictive pericarditis is curable by pericardiectomy, and failure to respond reflects an underlying myocardial disease. Fibrous epicarditis could account for residual cardiac constriction, and delayed hemodynamic response in some patients is an alternative explanation. To examine this, we studied the 12 consecutive patients with otherwise normal hearts treated with extensive pericardiectomy for constrictive pericarditis over the past 7 years. Three hemodynamic responses to pericardiectomy were observed: (1) rapid response, where central venous pressure (CVP) fell below 10 cm H2O by 24 hours in two patients; (2) delayed response, where CVP fell below 10 cm H2O by 48 hours in six patients; and (3) no response of CVP in four patients. The CVPs remained critically elevated (greater than 25 cm H2O) in three patients with delayed response until a sclerotic epicardial peel was resected. Another patient whose CVP of 30 cm H2O showed no change after parietal pericardiectomy was thought to have amyloid cardiomyopathy but instead at autopsy had constrictive epicardial sclerosis not recognized at parietal pericardiectomy. Histologic features of parietal pericardium had no correlation with hemodynamic response, whereas epicardial histology did correlate with hemodynamic response in four patients. The data showed a spectrum of postpericardiectomy delayed hemodynamic responses, which in some patients may be due to a slowly resolving or fixed component of fibrous epicarditis that may be clinically misconstrued as a cardiomyopathy. Interruption of visceral pericardial tissue may be as important as resection of the parietal pericardium in patients with epicardial sclerosis.

This article has been cited by other articles:

				T. Akasaka, K. Yoshida, A. Yamamuro, T. Hozumi, T. Takagi, S. Morioka, and J. Yoshikawa Phasic Coronary Flow Characteristics in Patients With Constrictive Pericarditis : Comparison With Restrictive Cardiomyopathy Circulation, September 16, 1997; 96(6): 1874 - 1881. [Abstract] [Full Text]

				W. H. Hartl, E. Kreuzer, E. Reuschel-Janetschek, D. Schmidt, and B. Reichart Pericardial mass mimicking constrictive pericarditis Ann. Thorac. Surg., September 1, 1991; 52(3): 557 - 559. [Abstract] [PDF]

				R. G. Johnson, R. L. Thurer, B. H. Lorell, and R. M. Weintraub Ultrasonic debridement of calcified pericardium in constrictive pericarditis Ann. Thorac. Surg., December 1, 1989; 48(6): 855 - 856. [Abstract] [PDF]

				L. I. Bonchek, M. W. Burlingame, and B. E. Vazales Postoperative Fibrous Cardiac Constriction Ann. Thorac. Surg., March 1, 1988; 45(3): 311 - 314. [Abstract] [PDF]

				R. O. Heimbecker, D. Smith, S. Shimizu, and J. Kestle Surgical Technique for the Management of Constrictive Epicarditis Complicating Constrictive Pericarditis (The Waffle Procedure) Ann. Thorac. Surg., November 1, 1983; 36(5): 605 - 606. [Abstract] [PDF]

				W. H. Lee and J. Fisher Right Ventricular Diastolic Disorders Arch Intern Med, February 1, 1983; 143(2): 332 - 337. [Abstract] [PDF]