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Transient right ventricular dysfunction after pericardiectomy in patients with constrictive pericarditis.

Yu HT, Ha JW, Lee S, Shim CY, Moon J, Cho IJ, Kang MK, Yang WI, Choi D, Chung N - Korean Circ J (2011)

Bottom Line: However, myocardial atrophy with prolonged pericardial constriction and abrupt increase in venous return can lead to heart failure with volume overload after pericardial decompression, especially in the right ventricle (RV).Echocardiography revealed a markedly dilated RV with decreased peak systolic velocity of the tricuspid annulus, suggesting severe RV dysfunction.After treatment with inotropics and diuretics, a follow-up echocardiography revealed an improved systolic function with decreased RV chamber size.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Division, Severence Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
Pericardiectomy is the standard treatment in patients with chronic constrictive pericarditis who have persistent symptoms. However, myocardial atrophy with prolonged pericardial constriction and abrupt increase in venous return can lead to heart failure with volume overload after pericardial decompression, especially in the right ventricle (RV). We experienced a 44 year old male patient who developed transient RV failure after pericardiectomy for constrictive pericarditis. Echocardiography revealed a markedly dilated RV with decreased peak systolic velocity of the tricuspid annulus, suggesting severe RV dysfunction. After treatment with inotropics and diuretics, a follow-up echocardiography revealed an improved systolic function with decreased RV chamber size. This case demonstrates the importance of volume overload and RV dysfunction in patients with constrictive pericarditis undergoing pericardiectomy.

No MeSH data available.


Related in: MedlinePlus

Two-dimensional echocardiography of the parasternal short-axis view (A, C and E) and apical 4-chamber view (B, D and F). The echocardiography showed pericardial thickening and relatively small sized RV (end-diastolic volume: 34.6 mL) at admission (A and B). Postoperative echocardiography revealed markedly dilated RV (end-diastolic volume: 85.6 mL) with D-shaped LV (C and D). The RV size was decreased (end-diastolic volume: 59.7 mL) on echocardiography after 7 months (E and F). RV: right ventricle, LV: left ventricle.
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Figure 3: Two-dimensional echocardiography of the parasternal short-axis view (A, C and E) and apical 4-chamber view (B, D and F). The echocardiography showed pericardial thickening and relatively small sized RV (end-diastolic volume: 34.6 mL) at admission (A and B). Postoperative echocardiography revealed markedly dilated RV (end-diastolic volume: 85.6 mL) with D-shaped LV (C and D). The RV size was decreased (end-diastolic volume: 59.7 mL) on echocardiography after 7 months (E and F). RV: right ventricle, LV: left ventricle.

Mentions: Physical examination revealed decreased breath sound at the right lower lung field and mild pitting edema on both pretibial areas. An electrocardiography showed a normal sinus rhythm at a rate of 93 beats/min, and a chest X-ray revealed cardiomegaly with bilateral pleural effusion. A two-dimensional echocardiography demonstrated pericardial thickening with adhesion, septal bouncing motion, and dilated inferior vena cava with plethora. Doppler showed respiratory variation of mitral inflow early velocity (42%) and expiratory diastolic flow reversal of the hepatic vein, suggesting constrictive pericarditis. It also revealed preserved early diastolic velocity (E' 9.0 cm/s) of the mitral annulus and normal peak systolic velocity (S' 15.5 cm/s) of the tricuspid annulus (Figs. 1A and 2A). The RV end-diastolic volume, RV end-systolic volume and RV ejection fraction were 34.6 mL, 20.3 mL and 41% (Fig. 3A and B). These findings were compatible with RV systolic dysfunction. With a diagnosis of constrictive pericarditis probably due to tuberculosis origin, anti-tuberculosis medication and diuretics were maintained.


Transient right ventricular dysfunction after pericardiectomy in patients with constrictive pericarditis.

Yu HT, Ha JW, Lee S, Shim CY, Moon J, Cho IJ, Kang MK, Yang WI, Choi D, Chung N - Korean Circ J (2011)

Two-dimensional echocardiography of the parasternal short-axis view (A, C and E) and apical 4-chamber view (B, D and F). The echocardiography showed pericardial thickening and relatively small sized RV (end-diastolic volume: 34.6 mL) at admission (A and B). Postoperative echocardiography revealed markedly dilated RV (end-diastolic volume: 85.6 mL) with D-shaped LV (C and D). The RV size was decreased (end-diastolic volume: 59.7 mL) on echocardiography after 7 months (E and F). RV: right ventricle, LV: left ventricle.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3116109&req=5

Figure 3: Two-dimensional echocardiography of the parasternal short-axis view (A, C and E) and apical 4-chamber view (B, D and F). The echocardiography showed pericardial thickening and relatively small sized RV (end-diastolic volume: 34.6 mL) at admission (A and B). Postoperative echocardiography revealed markedly dilated RV (end-diastolic volume: 85.6 mL) with D-shaped LV (C and D). The RV size was decreased (end-diastolic volume: 59.7 mL) on echocardiography after 7 months (E and F). RV: right ventricle, LV: left ventricle.
Mentions: Physical examination revealed decreased breath sound at the right lower lung field and mild pitting edema on both pretibial areas. An electrocardiography showed a normal sinus rhythm at a rate of 93 beats/min, and a chest X-ray revealed cardiomegaly with bilateral pleural effusion. A two-dimensional echocardiography demonstrated pericardial thickening with adhesion, septal bouncing motion, and dilated inferior vena cava with plethora. Doppler showed respiratory variation of mitral inflow early velocity (42%) and expiratory diastolic flow reversal of the hepatic vein, suggesting constrictive pericarditis. It also revealed preserved early diastolic velocity (E' 9.0 cm/s) of the mitral annulus and normal peak systolic velocity (S' 15.5 cm/s) of the tricuspid annulus (Figs. 1A and 2A). The RV end-diastolic volume, RV end-systolic volume and RV ejection fraction were 34.6 mL, 20.3 mL and 41% (Fig. 3A and B). These findings were compatible with RV systolic dysfunction. With a diagnosis of constrictive pericarditis probably due to tuberculosis origin, anti-tuberculosis medication and diuretics were maintained.

Bottom Line: However, myocardial atrophy with prolonged pericardial constriction and abrupt increase in venous return can lead to heart failure with volume overload after pericardial decompression, especially in the right ventricle (RV).Echocardiography revealed a markedly dilated RV with decreased peak systolic velocity of the tricuspid annulus, suggesting severe RV dysfunction.After treatment with inotropics and diuretics, a follow-up echocardiography revealed an improved systolic function with decreased RV chamber size.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Division, Severence Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
Pericardiectomy is the standard treatment in patients with chronic constrictive pericarditis who have persistent symptoms. However, myocardial atrophy with prolonged pericardial constriction and abrupt increase in venous return can lead to heart failure with volume overload after pericardial decompression, especially in the right ventricle (RV). We experienced a 44 year old male patient who developed transient RV failure after pericardiectomy for constrictive pericarditis. Echocardiography revealed a markedly dilated RV with decreased peak systolic velocity of the tricuspid annulus, suggesting severe RV dysfunction. After treatment with inotropics and diuretics, a follow-up echocardiography revealed an improved systolic function with decreased RV chamber size. This case demonstrates the importance of volume overload and RV dysfunction in patients with constrictive pericarditis undergoing pericardiectomy.

No MeSH data available.


Related in: MedlinePlus