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1/321. Pericardial heart disease: a study of its causes, consequences, and morphologic features.

    This report reviews morphologic aspects of pericardial heart disease. A morphologic classification for this condition is presented. An ideal classification of pericardial heart disease obviously would take into account clinical, etiologic and morphologic features of this condition but a single classification combining these three components is lacking. Pericardial heart disease is relatively uncommon clinically, and when present at necropsy it usually had not been recognized during life. The term "pericarditis" is inaccurate because most pericardial diseases are noninflammatory in nature. Morphologically chronic pericardial heart disease may present clinically as an acute illness. Even when clinical symptoms are present, however, few patients develop evidence of cardiac dysfunction (constriction). When pericardial constriction occurs, it is the result of increased pericardial fluid or increased pericardial tissue or both. Increased fluid is treated by drainage; increased tissue is treated by excision. In most patients with chronic constrictive pericarditis the etiology is not apparent even after histologic examination of pericardia. ( info)

2/321. Mitral regurgitation after pericardiectomy for constrictive pericarditis.

    We report a case of constrictive pericarditis in which trace mitral valve regurgitation was detected preoperatively and temporarily worsened after a pericardiectomy was performed. The early postoperative data suggested that the increased mobility of the lateral wall, in conjunction with an increase in the left ventricular volume, might be one of the causes of the perioperative mitral valve dysfunction. The mitral valve function returned to the preoperative baseline thirteen months after the pericardiectomy. ( info)

3/321. Echocardiographic findings in constrictive pericarditis. A case report.

    The echocardiographic findings in a 73-year-old woman with constrictive calcified pericarditis are presented. The diagnosis was confirmed by physical examination, chest x-rays and cardiac catheterization. The echocardiogram demonstrated abnormal motion of the interventricular septum and of the left ventricular posterior wall, multiple thickened echoes of the posterior pericardium, and a localized dense band of anterior pericardial echoes, which corresponded to the calcification seen on the chest X-ray. ( info)

4/321. Transient effusive-constrictive pericarditis due to chemotherapy.

    Commonly used chemotherapeutic agents, specifically cytarabine and daunorubicin, can cause effusive-constrictive pericarditis. We describe a case of transient effusive-constrictive pericarditis in a patient with acute myelogenous leukemia. This is the first case report of a patient with transient effusive-constrictive pericarditis due to chemotherapy. ( info)

5/321. Constrictive pericarditis and pleuropulmonary disease linked to ergot dopamine agonist therapy (cabergoline) for Parkinson's disease.

    Cabergoline is one of several ergoline dopamine agonist medications used in the treatment of Parkinson's disease (PD). We diagnosed constrictive pericarditis (CP) in a patient with PD receiving cabergoline therapy (10 mg daily), who had symptoms and signs of congestive heart failure (CHF). In the absence of previous reported cases of this condition linked to ergoline drugs, cabergoline was not initially identified as the cause. Shortly thereafter, however, the patient developed of a severe pleuropulmonary inflammatory-fibrotic syndrome, a recognized complication of ergoline medications, thus suggesting a common pathogenesis due to cabergoline therapy. To our knowledge, this is the first case in the English literature, although we speculate that CP may be more common than reported among patients with PD who are treated with an ergoline drug (cabergoline, bromocriptine, pergolide, or lisuride). The diagnosis of CP is difficult and requires a high level of suspicion; symptoms may masquerade as CHF due to common mechanisms such as coronary artery disease. In patients with PD who are taking not only cabergoline but also one of the other ergoline drugs, CP should be suspected if symptoms of CHF develop. ( info)

6/321. Constrictive pericarditis.

    The diagnosis of constrictive pericarditis remains a challenge because its physical findings and hemodynamics mimic restrictive cardiomyopathy. Various diagnostic advances over the years enable us to differentiate between these two conditions. This review begins with a case report of constrictive pericarditis, followed by a brief history and discussions of etiologies. Clinical features, radiologic, electrocardiographic, angiographic findings, and hemodynamics of constrictive pericarditis are reviewed. The echocardiographic findings are detailed and the recent advances in Doppler flow velocity patterns of pulmonary, mitral, tricuspid valves and hepatic veins are reported. Nuclear ventriculograms depict rapid ventricular filling in constrictive pericarditis and differentiate it from restrictive cardiomyopathy. Endomyocardial biopsy helps further in recognizing the various types of restrictive cardiomyopathies. Computed tomography and magnetic resonance imaging delineate abnormal pericardial thickness in constrictive pericarditis. association of characteristic hemodynamic changes and abnormal pericardial thickness > 3 mm usually confirms the diagnosis of constrictive pericarditis. Effusive and occult varieties of constrictive pericarditis are briefly described. This review concludes with emphasizing the importance of pericardial resection. ( info)

7/321. Localized pericarditis with calcifications mimicking a pericardial tumor.

    A 62-year-old man was admitted with increasing palpitations. radiography of the chest demonstrated a calcified mass. magnetic resonance imaging revealed compression of the right ventricle by a tumor. At the time of cardiac catheterization, the coronary arteries were found not to supply blood flow of the mass, and no dip-and-plateau pattern was seen in the right ventricular pressure measurements. At the time of surgery, the mass was found to be a focal calcified thickening of the pericardium containing only pus. The thickening resembled an oval pericardial tumor. Microbiologic examination of the pus revealed propionibacterium acnes. ( info)

8/321. Purulent pericarditis with tamponade in a postpartum patient due to group F streptococcus.

    Bacterial pericarditis with cardiac tamponade is a life-threatening disorder that has been associated with a variety of organisms. There is usually an associated underlying condition or a seeding of the pericardium from an infection elsewhere. We report the development of cardiac tamponade and a subsequent pericardial constriction due to group F streptococcus purulent pericarditis. We believe this to be the first report of a postpartum patient with purulent pericarditis. ( info)

9/321. Combined idiopathic retroperitoneal and mediastinal fibrosis with pericardial involvement.

    We report the case of a 54-year-old woman with renal failure related to bilateral hydronephrosis. Clinical and radiologic findings were consistent with retroperitoneal fibrosis associated with pleuro-pericardial involvement. These features matched criteria for combined idiopathic retroperitoneal fibrosis and idiopathic mediastinal fibrosis. There are few reported cases of pericardial involvement in this combined disorder. In our observation, nuclear-magnetic resonance was the radiologic procedure of choice for aortic exploration. The responsibility of therapeutic agents (beta-adrenoreceptor-blocking drugs and ergotamine) and therapeutic options for the sclerosing disease are also discussed. Bilateral ureteral stents and corticosteroids produced favorable outcome without recurrence one year after treatment was stopped. ( info)

10/321. Constrictive pericarditis following hemopericardium due to ascending aortic dissection: A case report.

    A 79-year-old woman, who had had no history of trauma, tuberculosis, or collagen diseases, was referred for examination of general fatigue and shortness of breath on exertion. physical examination revealed engorged neck veins, hepatomegaly, and ascites with abdominal distention. On chest x-ray the cardiac shadow was slightly enlarged and bilateral pleural effusion was present. An electrocardiogram showed low voltage of the QRS complex. Computed tomographic scans revealed two lumens in the remarkably dilated ascending aorta and the severely thickened pericardium. cardiac catheterization showed elevated right atrial pressure and elevated right and left ventricular end-diastolic pressures, in addition to a pressure record of early diastolic dip and end-systolic plateau in the right ventricle. aortography demonstrated aortic dissection localized to the ascending aorta. On the basis of these findings, the diagnosis of chronic ascending aortic dissection complicated with constrictive pericarditis was made. After subtotal pericardiectomy, graft replacement of the ascending aorta and proximal aortic arch was performed with successful results. Her postoperative recovery was uneventful. Histological studies of the pericardium showed fibrosis and marked infiltration of the inflammatory cells. No findings of specific pericarditis such as tuberculosis or collagen diseases were detected. ( info)
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