Case studies
Restrictive pericarditis
M Y Heneina, R D Rakhita, M N Sheppardb, D G Gibsona
a Cardiac Department,
Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK, b Histopathology Department, Royal Brompton
Hospital
Correspondence to: Dr Gibson
Accepted for publication 30 November 1998
BACKGROUND
Pericardial
thickening is an uncommon complication of cardiac surgery.
OBJECTIVESTo study
pericardial thickening as the cause of severe postoperative venous congestion.
SUBJECTSTwo men, one
with severe aortic stenosis and single coronary artery disease, and one
with coronary artery disease after an old inferior infarction. Both had
coronary artery bypass grafting surgery.
METHODSMagnetic
resonance imaging (MRI), Doppler echocardiography, and cardiac catheterisation.
RESULTSVenous
pressure was raised in both patients. MRI showed mildly thickened
pericardium, and cardiac catheterisation indicated diastolic
equalisation of pressures in the four chambers. Jugular venous pulse
showed a dominant "Y" descent coinciding with early diastolic flow
in the superior vena cava, and mitral and tricuspid Doppler forward
flow proved restrictive physiology. The clinical background suggested
pericardial disease so both patients had pericardiectomy. This proved
the pericardium to be thickened; the extent of fibrosis also involved
the epicardium.
CONCLUSIONSAlthough
rare, restrictive pericarditis (restrictive ventricular physiology
resulting from pericardial disease) should be considered to be a
separate diagnostic entity because its pathological basis and treatment
are different from intrinsic myocardial disease. This diagnosis may be
confirmed by standard investigational techniques or may require
diagnostic thoracotomy.
Keywords: restrictive pericarditis; pericardial disease
© 1999 by Heart
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