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(Circulation. 2005;111:e365-e366.)
© 2005 American Heart Association, Inc.

Images in Cardiovascular Medicine

Constrictive Epicarditis as an Unusual Cause of Constrictive Physiology

Typical Presentation With Unusual Pathology

Jong-Won Ha, MD, PhD; Byung-Chul Chang, MD, PhD; Byoung-Wook Choi, MD; Namsik Chung, MD, PhD; Won-Heum Shim, MD, PhD; Seung-Yun Cho, MD, PhD; Sung-Soon Kim, MD, PhD

From the Divisions of Cardiology, Cardiovascular Surgery and Diagnostic Radiology, Yonsei University College of Medicine, Seoul, South Korea.

Correspondence to Jong-Won Ha, Cardiology Division, Yonsei University College of Medicine, Yonsei Cardiovascular Center, CPO Box 8044, Seoul, South Korea 120-752. E-mail jwha{at}yumc.yonsei.ac.kr

This case represents typical clinical and hemodynamic features of constrictive pericarditis, but the underlying pathology was epicardial rather than pericardial scarring. The recognition of constrictive epicarditis as distinct from pericarditis is important because the surgical approach is different.

An 83-year-old woman was evaluated for progressively worsening exertional dyspnea and generalized edema. On physical examination, the jugular vein was distended and the liver was enlarged. An ECG showed atrial fibrillation. A chest lateral film showed a pericardial calcification (Figure 1). Computed tomography of the heart showed a calcification ring encircling the ventricle (Figure 2). Calcific constrictive pericarditis was diagnosed, and pericardiectomy was planned. At surgery, the parietal pericardium was mildly fibrothickened; however, dense, calcified, ossified epicardial thickening firmly attached especially on the left and right atrioventricular groove, which constituted the basis for marked impaired filling of the left ventricle (Figures 3 and 4 ; Data Supplement). The lesion was removed after careful dissection via scalpel. The woman’s central venous pressure dropped from 17 mm Hg to 11 mm Hg after the operation. The patient subsequently recovered and was uneventfully discharged days later.

View larger version (128K): [in this window] [in a new window]   Figure 1. Pericardial calcification.

View larger version (127K): [in this window] [in a new window]   Figure 2. Calcification ring encircling the ventricle.

View larger version (100K): [in this window] [in a new window]   Figure 3. Surgical findings.

View larger version (119K): [in this window] [in a new window]   Figure 4. Removed calcifications.

	Footnotes

 
The online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/111/21/e365/DC1.

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Circulation 2005 111: 2711. [Full Text]

This Article Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ha, J.-W. Articles by Kim, S.-S. Search for Related Content PubMed PubMed Citation Articles by Ha, J.-W. Articles by Kim, S.-S. Related Collections Pericardial disease CV surgery: other Related Article