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Acute right-sided heart failure(ARHF) can be caused by many acute cardiopulmonary diseases in children, and right heart function is an important determinant of the outcome and prognosis of many cardiopulmonary diseases.ARHF in children has rapid onset, rapid change, atypical clinical manifestations, and is more likely to cause serious hemodynamic changes and consequences if not treated in time.The effectiveness of treatment lies in the timely identification of ARHF, the accurate evaluation and monitoring of the hemodynamic status of children, and on this basis, the personalized and rational treatment combined with the primary disease.
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A 71-year-old woman underwent VVI pacemaker implantation for complete atrioventricular block 38 years ago at the cardiovascular department of another hospital. In the course of observation, she developed atrial fibrillation. One year ago, she was admitted to hospital for aggravated congestive heart failure and was subsequently treated by a cardiovascular practitioner. She had persistent shortness of breath and lower leg edema, which were treated with increasing doses of oral diuretics. Due to poor treatment outcomes, she was referred to our hospital. Her echocardiography results suggested severe tricuspid regurgitation (TR) and moderate mitral regurgitation. She was also found to have impaired renal function and liver cirrhosis (Stage A of the Child classification), and was admitted. In addition, she had undernutrition with suspected cardiac cachexia. She was first treated by inotrope infusion and central venous hyperalimentation before tricuspid annuloplasty and mitral valvuloplasty were performed. Even though her postoperative management was complicated, she was discharged from our hospital. The conservative treatment with the increased dose of the diuretic for TR-associated right heart failure was prolonged in this patient, leading to severe right heart failure and aggravation of impaired renal function or congestive liver-associated hepatic disorders. Eventually, the patient required operative intervention; however, postoperative management is usually complex, and the operation result may be poor in such patients. We suggest that, from the time when right heart failure can be managed with relatively small doses of diuretics, surgeons should be involved in the care of patients with severe TR who do not require left heart valvular surgery, and should discuss the necessity of surgery earlier than the relevant guidelines suggest, depending on the patient's condition.
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OBJECTIVE To observe th e efficacy and safety of intermittently repeated application of levosimendan in the treatment of right heart failure of pulmonary hypertension. METHODS A total of 70 cases of right heart failure of pulmonary hypertension were collected from the First Affiliated Hospital of Guangxi Medical University during Jan. 2019-May 2021，and then randomly divided into control group and observation group ，with 35 cases in each group.In control group ，the patients with moderate risk of classification of pulmonary hypertension were given Tadalafil tablets and Ambrisentan tablets ，while the patients with high risk were given Tadalafil tablets ，Ambrisentan tablets and Treprostinil injection ；both were given anti-right heart failure drugs at the same time. On the basis of treatment in the control group ，patients in the observation group were additionally intravenously pumped with levosimendan injection 12.5 mg，once a month ，at a rate of 0.05-0.1 μg/（kg·min），3 months in total. Response rate of therapy ，improvement of risk stratification of pulmonary hypertension after treatment ，and average pulmonary artery pressure ，six-minute walk distance （6MWD），serum level of N-terminal pro brain natriuretic peptide （NT-proBNP），right atrial pressure （RAP），oxygen saturation in mixed venous blood （SvO2），cardiac index （CI），right ventricular ejection fraction （RVEF），early diastolic tricuspid inflow velocity/early diastolic tricuspid annular velocity （E/Ea），tricuspid annular plane systolic excursion（TAPSE），right ventricular end-diastolic diameter （RVEDD），right ventricular end-systolic diameter （RVESD）before and after treatment ，and the occurrence of adverse reactions were observed in 2 groups. RESULTS The total response rate of observation group was significantly higher than control group after treatment （P＜0.05）. After treatment ，average pulmonary artery pressure，NT-proBNP level ，RAP，E/Ea，RVEDD and RVESD of 2 groups were significantly lower than before treatment ，while 6MWD，SvO2， CI， TAPSE and RVEF were significantly higher than before treatment ；NT-proBNP level and E/Ea of observation group were significantly lower than control group ， while 6MWD，CI，TAPSE and RVEF were significantly higher than control group （P＜0.05 or P＜0.01）. There was no significant difference in average pulmonary artery pressure ， risk stratification improvement cases of pulmonary hypertension ， RAP， SvO2， RVEDD， RVESD and the incidence of asymptomatic hypotension between 2 groups（P＞0.05）. CONCLUSIONS Intermittently repeated application of levosimendan can improve the function of right heart of pulmonary hypertension complicated with right heart failure and has good safety.
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Objective:To investigate the value of real-time shear wave elastography (SWE) in the assessment of splenic congestion in patients with chronic right heart failure.Methods:Sixty patients with chronic right heart failure with cardiac function grade Ⅱ-Ⅳ of New York Heart Association (NYHA) treated in Lianyungang First People′s Hospital from March 2020 to February 2021 were collected as the study group, and 20 healthy subjects in the same period were selected as the control group. Routine echocardiography was performed on all subjects; spleen stiffness measurement (SSM) was detected by SWE, and blood biochemical indicators related to patients with right heart failure were detected and recorded. SSM and other related parameters between the two groups were analyzed; the SSM in patients of different cardiac function classifications and course of disease were compared; 60 patients were divided into low SSM group (SSM≤15.0 kPa), middle SSM group (15.0 kPa<SSM<21.3 kPa) and high SSM group (SSM≥21.3 kPa) according to the measured SSM (9.1-34.5 kPa). The differences in clinical indicators between the three groups were analyzed and compared, and the adverse events of the three groups were analyzed by the kaplan-Meier (KM) method. Receiver operating characteristic (ROC) curve was used to evaluate the value of SSM for predicting right atrial pressure (RAP)≥10 mmHg in patients with chronic right heart failure. Multiple linear regression was used to analyze the independent risk factors of increased SSM in patients with chronic right heart failure.Results:Compared with the control group [(10.23±1.95)kPa], the SSM of the study group [(22.09±6.99)kPa] was significantly higher, and the difference between the two groups was statistically significant ( P<0.05); the SSM in patients with cardiac function grade Ⅳ [(25.24±4.53)kPa] was higher than those of grade Ⅲ [(16.71±3.12)kPa] and grade Ⅱ [(11.89±2.10)kPa] (all P<0.001); the SSM in patients with course of disease≥1 year [(24.71±4.61)kPa] was higher than those with a course of <1 year [(14.95±4.00)kPa] ( P<0.001); Compared with the low SSM group and the middle SSM group, the estimated RAP, N-terminal pro B-type natriuretic peptide (NT pro-BNP) and right atrial volume index (RAVI) of the high SSM group were higher (all P<0.05), and the inferior vena cava collapsible index (IVC-CI) was lower ( P<0.05). KM survival analysis showed that the incidence of adverse events in high SSM group was significantly higher compared with the middle SSM group and lower SSM group ( P<0.001). SSM in patients with right heart failure was positively correlated with NT pro-BNP, estimated RAP, and RAVI (all P<0.05), negatively correlated with IVC-CI ( P<0.05); When SSM≥26.1 kPa, the area under ROC curve was of predicting RAP≥10 mmHg 0.863 (95% CI: 0.771-0.955), and the sensitivity and specificity were 76.5% and 81.4%. Multiple linear stepwise regression analysis showed that NT pro-BNP, estimated RAP and IVC-CI were independent risk factors of SSM in patients with chronic right heart failure. Conclusions:The increase of SSM can reflect the increase of RAP, the severity of right heart failure and heart failure. The detection of SSM by SWE technology can conveniently and effectively monitor and evaluate the degree of splenic congestion and injury.
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Acute cor pulmonale, usually secondary to pulmonary hypertension induced from severe pulmonary diseases or pulmonary circulation disorders, is characterized by acute right heart dysfunction and right heart failure.Hypoxemia, hypercapnia and positive pressure ventilation can all lead to pulmonary hypertension.During the treatment of critically ill children, especially in the process of respiratory support, acute cor pulmonale should be identified as soon as possible to consider the implementation of "lung protection" and "circulation protection" with monitoring of right heart function and protection as the core.
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In recent years, more and more attention has been paid to the evaluation and management of right heart function, for which point-of-care unltrasound provides more opportunities. A patient with acute right heart failure after tricuspid valve replacement was successfully treated in department of critical care medicine of Wuxi People's Hospital Affiliated to Nanjing Medical University. This patient showed typical manifestations of acute right heart failure by point-of-care ultrasound. The overall right ventricular systolic function was weakened, and the right ventricle was enlarged. Ratio of the diameter for right ventricle to left ventricle was greater than 1. In the parasternal short-axis view, the right ventricle was oval, and ventricular septum was convex to the left ventricle. The preload of left ventricular was low and the left ventricular diastolic function was limited. Under the guidance of point-of-care ultrasound, the patient's condition tended to improve after treatments such as strengthening the heart, adjusting the preload and afterload of the left and right ventricles, improving renal blood perfusion, and respiratory support. The right ventricle was smaller than before, the systolic function of right ventricle and diastolic function of left ventricle were improved. The successful treatment experience of this case is summarized for reference.
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Introduction: Pulmonary Embolism is a major health problemwhich is associated with significant mortality and morbidity. Itis a common and lethal condition. This study was undertakento find the association between NT-Pro-BNP levels and thelocalisation of thrombus in acute Pulmonary Embolism and toprognosticate the patients.Material and methods: Prospective study conducted ata tertiary care hospital.Thirty patients with PulmonaryEmbolism of various etiologies, confirmed with clinicalfeatures, laboratory investigations and imaging and fulfillingthe inclusion and exclusion criteria were included. Aftergetting informed consent, Blood samples for assessmentof NT-Pro-BNP levels were collected within 24 hours ofadmission.Results: In 19 patients, the thrombus was located centrally(in main pulmonary artery) whereas in 11 patients, thethrombus was located in the peripherally (in segmental andsubsegmental pulmonary arteries). 22 participants of thestudy had normal clinical outcome. 5 patients were morbid(oxygen dependant/ heart failure) whereas 3 patients died.Patients with central pulmonary embolus had higher NT-ProBNP levels whereas patients with pulmonary embolus in thesegmental or subsegmental pulmonary arteries had relativelyless NTPro-BNP levels. Patients with high NT-Pro-BNPlevels had complicated in-hospital course/ mortality whereas,patients with relatively lower NT-Pro-BNP had uncomplicatedin-hospital course.Conclusion: This study shows that higher NT-Pro-BNPlevels indicate higher probability of a more central locationof thrombus in pulmonary embolism and also right ventricularoverload. Also patients with higher NT-Pro-BNP levels had acomplicated in hospital course.
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We report a surgical case of severe tricuspid regurgitation with hemodynamic features mimicking constrictive pericarditis. A catheterization study showed a dip and plateau pattern of right and left ventricular pressure. Intraoperative finding : the pericardium was not adherent to the epicardial wall. The tricuspid regurgitation was successfully repaired by cleft suture and tricuspid annuloplasty. After surgery, the echocardiographic features mimicking constrictive pericarditis were normalized.
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Resumen El ventrículo derecho, históricamente, ha sido en gran medida olvidado e y la gran mayoría de las técnicas diagnósticas,los abordajes terapéuticos y las investigaciones clínicas están dirigidas al ventrículo izquierdo. Con una anatomía y fisiologíamuy diferente a su contraparte izquierda, el ventrículo derecho dispone de limitadas opciones terapéuticas cuando éste falla, lo cual empeora enormemente el pronóstico del paciente. La presente revisión pretende hacer un análisis de la anatomía, fisiología, fisiopatología, estudios de imagen y tratamiento de la falla ventricular derecha con el fin de retomar su importancia en la cardiología actual.
Abstract The right ventricle has been, historically, largely forgotten and the vast majority of diagnostic techniques, therapeutic approaches and clinical research are directed to the left ventricle. With a very different anatomy and physiology from its left counterpart, the right ventricle has limited therapeutic options when it fails, which greatly worsens the patient's prognosis. The present review intends to analyze the anatomy, physiology, physiopathology, imaging studies and treatment of right ventricular failure in order to resume its importance in current cardiology.
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Humans , Ventricular Dysfunction, Right , Costa Rica , Heart Failure , Heart Ventricles/anatomy & histology , Heart Ventricles/physiopathology , Heart Ventricles/pathologyABSTRACT
Background: COPD is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. It leads to cor pulmonale causing right ventricular failure. Present study compares the serum level of CA-125 and 2 D Echo for detection of right ventricular failure in COPD patients.Methods: In this study 178 patients suffering from COPD has been taken after following inclusion and exclusion criteria and informed consent. Serum CA 125 levels are evaluated in all patients and compared with the right ventricular functions.Results: The mean CA125 was higher in subjects with RV failure (96.32) as compared to those subjects with RV normal (37.17). The result was statistically significant. (p<0.001). The mean duration of illness was higher in subjects with raised CA125 (8.71 years) as compared to those with normal CA 125 (6.67 years) and the difference was also statistically significant (P<0.001).Conclusions: CA-125 levels have a good sensitivity and specificity for predicting right ventricular failure in COPD patients. Diagnostic accuracy, high positive and negative predictive value makes CA-125 a good predictor of right ventricular failure in COPD patients.
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Objective • To investigate the relationship between the red blood cell distribution width (RDW) and the severity of right heart failure in patients with chronic obstructive pulmonary disease (COPD). Methods • A total of 265 patients with simple COPD and 268 COPD patients with right heart failure admitted to Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from October 2011 to September 2016 were enrolled. According to the New York Heart Association (NYHA) criteria, all COPD patients with right heart failure were divided into Group A (Class ), Group B (Class Ⅱ), Group C (Class III) and Group D (Class ). The RDW, mean corpuscular volume (MCV), pro-brain natriuretic peptide, and erythrocyte sedimentation rate were measured within 24 h after admission for all patients. The RDW trends and related influencing factors in different groups were analyzed and compared. Results • There was no significant difference in the gender, age, forced expiratory volume in one second (FEV1), and COPD exacerbation times between the COPD group and the COPD with right heart failure group (all P>0.05). However, there was a significant difference in red blood cell count (RBC), hemoglobin, MCV, RDW, pro-brain natriuretic peptide, and arterial partial pressure of oxygen (PaO2) (all P0.05). With the increase of the patients' NYHA functional class, both pro-brain natriuretic peptide and RDW showed a similarly significant increase (both P=0.000). Through further multiple comparisons of RDW among four groups, there was a significant difference between any two groups (all P<0.05). Conclusion • RDW in patients with COPD with right heart failure is significantly elevated, and is closely related to right heart failure.
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Objective To summarize the value of extracorporeal membrane oxygenation (ECMO) in right ventricular failure after heart transplantation. Methods Data of 31 cases with orthotopic heart transplantations from January 2016 to January 2018, in Tianjin First Central Hospital were retrospectively analyzed. Three patients received ECMO support because of right ventricular failure after operation.There were two males and one female in these three patients.Their ages were 52,38 and 67 years old.ECMO was performed in the heart transplantation(2 patients)and eight hours after the surgery. ECMO was established in these patients via femoral artery and femoral vein,V-A model.The mean blood flow was about 3.0 L/min.Continuous ventilator supports,low temperature sedation,anti-infection and nutrition support therapy were applied in the ECMO procedure.Results ECMO was weaned off successfully in all three patients.The time for ECMO was(144-177) h. All three patients were treated with continuous renal replacement therapy (CRRT). One patient had renal failure, the transition was given to regular dialysis after CRRT treatment, and the regular dialysis treatment after discharged from hospital.The ventilator time was(168.6±24.6)h in the three patients.The duration of staying in the intensive care unit was (31.8 ± 12.5) d. All three patients were discharged from the hospital successfully, and their cardiac function was normal. Conclusion ECMO can be used to treat right heart failure after heart transplantation,and the clinical effect is satisfactory.
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Objective·To investigate the relationship between the red blood cell distribution width (RDW) and the severity of right heart failure in patients with chronic obstructive pulmonary disease (COPD). Methods?·?A total of 265 patients with simple COPD and 268 COPD patients with right heart failure admitted to Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from October 2011 to September 2016 were enrolled. According to the New York Heart Association (NYHA) criteria, all COPD patients with right heart failure were divided into Group A (ClassⅠ), Group B (Class Ⅱ), Group C (Class Ⅲ) and Group D (Class Ⅳ). The RDW, mean corpuscular volume (MCV), pro-brain natriuretic peptide, and erythrocyte sedimentation rate were measured within 24 h after admission for all patients. The RDW trends and related influencing factors in different groups were analyzed and compared. Results?·?There was no significant difference in the gender, age, forced expiratory volume in one second (FEV1), and COPD exacerbation times between the COPD group and the COPD with right heart failure group (all P>0.05). However, there was a significant difference in red blood cell count (RBC), hemoglobin, MCV, RDW, pro-brain natriuretic peptide, and arterial partial pressure of oxygen (PaO2) (all P<0.05). In COPD with right heart failure group, there was no significant difference in age, RBC, hemoglobin, MCV, and PaO2among the four groups (all P>0.05). With the increase of the patients′ NYHA functional class, both pro-brain natriuretic peptide and RDW showed a similarly significant increase (both P=0.000). Through further multiple comparisons of RDW among four groups, there was a significant difference between any two groups (all P<0.05). Conclusion?·?RDW in patients with COPD with right heart failure is significantly elevated, and is closely related to right heart failure.
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<p><b>Background</b>The incidence of Ebstein's anomaly is extremely low, and except for the Mayo Clinic, no cardiac center has reported on a sufficient number of patients. The aim of our study was to report the outcomes of Ebstein's anomaly patients treated with tricuspid valvuloplasty (TVP) or tricuspid valve replacement (TVR).</p><p><b>Methods</b>TVP or TVR was performed in 245 patients from July 2006 to April 2016. We reviewed patients' records and contacted patients via outpatient service and over the telephone.</p><p><b>Results</b>The mean follow-up time was 43.6 ± 32.6 months, and 224 (91.4%) patients underwent follow-up. The mean operative age was 31.2 ± 15.7 years. TVR was performed in 23 patients, and TVP was performed in 201 patients. The 30-day mortality rate was 1.3%, and the overall survival rate was 97.9% at 5 and 10 years. The early mortality rate of the TVP group was lower than that of the TVR group (0.5% vs. 8.7%, P = 0.028), and the overall mortality rate of the TVP group was lower than that of the TVR group, without statistical significance (1.0% vs. 8.7%). After propensity score matching, the rates of mortality and New York Heart Association class ≥ III were lower in the TVP group than those in the TVR group without statistical significance. Seven patients with Type B Wolff-Parkinson-White (WPW) syndrome underwent one-stage surgery, and arrhythmias disappeared. Six patients suffered from episodes of left ventricular outflow tract obstruction (LVOTO) during surgery. Severe LVOTO could be treated with reoperation of the atrialized right ventricle.</p><p><b>Conclusions</b>Ebstein's anomaly patients treated with TVP or TVR can experience optimal outcomes with midterm follow-up. However, TVP should be the first-choice treatment. Optimal outcomes can be obtained from one-stage operation in patients with Type B WPW syndrome. Severe LVOTO during surgery might be related to improper operation of the atrialized right ventricle.</p>
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Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Cardiac Surgical Procedures , Methods , Ebstein Anomaly , General Surgery , Plastic Surgery Procedures , Methods , Retrospective Studies , Tricuspid Valve , General Surgery , Tricuspid Valve Insufficiency , General SurgeryABSTRACT
Objective To compared the clinical data of dilated cardiomyopathy (DCM) patients who were only left or right heart failure with the DCM patients who were right heart failure as the main clinical manifestations. Methods During January 2013 to January 2017, 25 cases of DCM with right heart failure as the main clinical manifestations, 55 cases of DCM with only left heart failure and 10 cases of DCM with only right heart failure were admitted in our department. The demographic and clinical data, echocardiography, brain natriuretic peptide(BNP) and serum total bilirubin were analyzed. Results Sex, age, course of disease and vital signs were similar between the three groups, while the left ventricular end diastolic diamesion[(76.3±13.7)mm,(67.6±12.3)mm, (59.4±4.2)mm], dimension of the left atrium[(58.5±9.3)mm, (47.4±7.2)mm, (49.0±6.5) mm], pulmonary artery pressure[(55.2±12.4)mmHg, (37.8±7.7)mmHg, (35.9±7.1)mmHg], incidence of pericardial effusion(9/25, 6/55, 1/10), BNP level[(1378.3±441.6)ng/mL, (897.2±353.4)ng/mL (766.4±381.7)ng/mL] were significantly higher while left ventricular ejection fraction(LVEF) was significantly lower in DCM with right heart failure as the main clinical manifestations than those in DCM with only left or right heart failure[(44.6±28.3)μmol/L, (20.1±11.7) μmol/L,P<0.05]. Conclusion DCM patients with right heart failure as the main clinical manifestations is linked with worse clinical features than DCM patients with only left or right heart failure.
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Objective To compared the clinical data of dilated cardiomyopathy (DCM) patients who were only left or right heart failure with the DCM patients who were right heart failure as the main clinical manifestations. Methods During January 2013 to January 2017, 25 cases of DCM with right heart failure as the main clinical manifestations, 55 cases of DCM with only left heart failure and 10 cases of DCM with only right heart failure were admitted in our department. The demographic and clinical data, echocardiography, brain natriuretic peptide(BNP) and serum total bilirubin were analyzed. Results Sex, age, course of disease and vital signs were similar between the three groups, while the left ventricular end diastolic diamesion[(76.3±13.7)mm,(67.6±12.3)mm, (59.4±4.2)mm], dimension of the left atrium[(58.5±9.3)mm, (47.4±7.2)mm, (49.0±6.5) mm], pulmonary artery pressure[(55.2±12.4)mmHg, (37.8±7.7)mmHg, (35.9±7.1)mmHg], incidence of pericardial effusion(9/25, 6/55, 1/10), BNP level[(1378.3±441.6)ng/mL, (897.2±353.4)ng/mL (766.4±381.7)ng/mL] were significantly higher while left ventricular ejection fraction(LVEF) was significantly lower in DCM with right heart failure as the main clinical manifestations than those in DCM with only left or right heart failure[(44.6±28.3)μmol/L, (20.1±11.7) μmol/L,P<0.05]. Conclusion DCM patients with right heart failure as the main clinical manifestations is linked with worse clinical features than DCM patients with only left or right heart failure.
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There is a wide variety of diseases resulting in pediatric right heart failure because of children′s special disease spectrum,the main mechanisms include pressure or volume overload,myocardial lesions and arrhythmia,etc.On the basis of adult studies,tailored treatment should be considered in pediatric patients.
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A 75-year-old woman presented with dyspnea, and was admitted urgently on a diagnosis of concurrent acute cardiac insufficiency. Because of her low blood pressure and respiratory failure, care was started in the intensive care unit. A transthoracic echocardiogram (TTE) showed severe tricuspid regurgitation (TR). We concluded that her cardiogenic shock was caused by acute right heart failure with severe TR and therefore carried out emergency surgery. We noted expansion of the tricuspid valve ring and shortening of the tendinous cord, and the leaflet was pulled into the right ventricle side. Initially we attempted a tricuspid annuloplasty (TAP), but it proved difficult to control the TR. We therefore performed a tricuspid valve replacement (TVR). The patient was moved from the intensive care unit to a general ward 10 days after the operation, and to another hospital 26 days later.
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We report a rare case of a 70-year old woman who suffered right ventricular failure and shock with a comparatively rapid course due to a huge primary right atrial malignant lymphoma occupying the right atrium. She had undergone mitral valve replacement and tricuspid valve annuloplasty due to combined valvular disease 12 years previously, and she had been treated for liver cirrhosis due to hepatitis C. The transthoracic echocardiography and the computed tomography scan revealed a huge tumor occupying the right atrial cavity and incarceration into the tricuspid valve ring. We performed an emergency operation to resect the heart tumor. As the tumor strongly adhered to the free wall of the right atrium and the tricuspid valve ring, we performed complete resection of the right atrial free wall and tricuspid valve. Therefore, we performed tricuspid valve replacement with a bioprosthesis, and reconstruction of the right free wall with an EPTFE sheet. The pathological examination of the tumor was consistent with malignant lymphoma of B-cell origin. These surgical procedures were effective to reduce acute right heart failure due to severe tricuspid valve regurgitation, but she died 3 months after surgery because of liver failure due to cirrhosis. Even though the operation was not curative, it might have been effective for preventing sudden death and acute right ventricular heart failure due to incarceration into the tricuspid valve ring of the huge right atrial tumor.
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La pericarditis constrictiva (PC) crónica es una entidad infrecuente, pero incapacitante y potencialmente fatal, cuyo diagnóstico supone un desafío para los facultativos. Su diagnóstico se basa en la existencia de una afectación hemodinámica, una fisiopatología de constricción y, en la mayoría de los casos, de un pericardio engrosado, y a menudo, también calcificado. La ecocardiografía es la técnica de elección y la más utilizada en la evaluación inicial de pacientes con sospecha de patología pericárdica, dado que, principalmente, permite determinar numerosos parámetros que demuestran la fisiopatología constrictiva. La pericardiectomía es el tratamiento de elección de la PC crónica con clínica persistente, siendo el pronóstico muy bueno si se realiza de forma precoz. Se reporta el caso de un varón de 72 años en el que, como ocurre con frecuencia, el diagnóstico y tratamiento de la PC sintomática se realizó tras numerosas visitas y exploraciones y en una fase avanzada de la enfermedad.
The chronic constrictive pericarditis (CP) is an uncommon, disabling and potentially fatal disease but whose diagnosis is a challenge for physicians. Diagnosis is based on the existence of hemodynamic compromise, pathophysiology constriction and, in most cases, a thickened pericardium and often also calcified. Echocardiography is the technique of choice and the most used in the initial evaluation of patients with suspected pericardial disease, because, mainly, to determine many parameters those demonstrate the constrictive pathophysiology. Pericardiectomy is the treatment of choice for chronic CP with persistent clinical, with very good prognosis if performed early. We report the case of a man of 72 years in which, as often happens, the diagnosis and treatment of CP was reached after numerous visits and examinations and in an advanced stage of the disease.
A pericardite constritiva (PC) crônica é uma doença rara, incapacitante e potencialmente fatal, mas cujo diagnóstico é um desafio para os médicos. O diagnóstico baseia-se na existência de um compromisso hemodinâmico, com uma fisiopatologia de constrição e ,na maioria dos casos, um pericárdio espessado e frequentemente também calcificado. O ecocardiograma é a técnica de escolha e os mais utilizados na avaliação inicial de pacientes com suspeita de doenças do pericárdio, pois principalmente, ajuda a determinar vários parâmetros que demonstram a fisiopatologia constritiva. A pericardiectomia é o tratamento de escolha para a PC crônica com clínica persistente, e o prognóstico é muito bom se for feito precocemente. Relatamos o caso de um homem de 72 anos em que, como muitas vezes acontece, o diagnóstico e tratamento da PC foi alcançado após inúmeras visitas e exames e em um estágio avançado da doença.