RESUMEN
Pericardial diseases have gained renewed clinical interest, leading to a renaissance in the field. There have been many recent advances in pericardial diseases in both multimodality cardiac imaging of diagnoses, such as recurrent, transient constrictive and effusive-constrictive pericarditis, and targeted therapeutics, especially anti-interleukin (IL)-1 agents that affect the inflammasome as part of autoinflammatory pathophysiology. There remains a large educational gap for clinicians, leading to variability in evaluation and management of these patients. The latest pericardial imaging (American Society of Echocardiography, European Association of Cardiovascular Imaging) and clinical guidelines (European Society of Cardiology) are >8-10 years of age and may not reflect current practice. Recent clinical trials involving anti-IL-1 agents in recurrent pericarditis, including anakinra (AIRTRIP), rilonacept (RHAPSODY), and goflikicept have demonstrated their efficacy. The present document represents an international position statement from world leaders in the pericardial field, focusing on novel concepts and emphasizing the role of multimodality cardiac imaging as well as new therapeutics in pericardial diseases.
Asunto(s)
Consenso , Imagen Multimodal , Pericardio , Valor Predictivo de las Pruebas , Humanos , Imagen Multimodal/normas , Pericardio/diagnóstico por imagen , Difusión de Innovaciones , Pronóstico , Pericarditis/diagnóstico por imagen , Pericarditis/terapia , Pericarditis/fisiopatología , Pericarditis/tratamiento farmacológico , Pericarditis Constrictiva/diagnóstico por imagen , Pericarditis Constrictiva/fisiopatología , Pericarditis Constrictiva/terapia , Técnicas de Imagen Cardíaca/normasRESUMEN
PURPOSE: Pericardiectomy is the definitive treatment option for constrictive pericarditis and is associated with a high prevalence of morbidity and mortality. However, information on the associated outcomes and risk factors is limited. We aimed to report the mid-term outcomes of pericardiectomy from a single center in China. METHODS: We retrospectively reviewed data collected from patients who underwent pericardiectomy at our institute from April 2018 to January 2023. RESULTS: Eighty-six consecutive patients (average age, 46.1 ± 14.7 years; 68.6 men) underwent pericardiectomy through midline sternotomy. The most common etiology was idiopathic (n = 60, 69.8%), and 82 patients (95.3%) were in the New York Heart Association function class III/IV. In all, 32 (37.2%) patients underwent redo sternotomies, 36 (41.9%) underwent a concomitant procedure, and 39 (45.3%) required cardiopulmonary bypass. The 30-day mortality rate was 5.8%, and the 1-year and 5-year survival rates were 88.3% and 83.5%, respectively. Multivariable analysis revealed that preoperative mitral insufficiency (MI) ≥moderate (hazard ratio [HR], 6.435; 95% confidence interval [CI] [1.655-25.009]; p = 0.007) and partial pericardiectomy (HR, 11.410; 95% CI [3.052-42.663]; p = 0.000) were associated with increased 5-year mortality. CONCLUSION: Pericardiectomy remains a safe operation for constrictive pericarditis with optimal mid-term outcomes.
Asunto(s)
Pericardiectomía , Pericarditis Constrictiva , Humanos , Pericarditis Constrictiva/cirugía , Pericarditis Constrictiva/mortalidad , Pericarditis Constrictiva/fisiopatología , Pericarditis Constrictiva/diagnóstico por imagen , Estudios Retrospectivos , Masculino , Pericardiectomía/efectos adversos , Pericardiectomía/mortalidad , Persona de Mediana Edad , Femenino , Factores de Riesgo , Adulto , Resultado del Tratamiento , Factores de Tiempo , China/epidemiología , Medición de Riesgo , Anciano , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/etiología , Esternotomía/efectos adversos , Esternotomía/mortalidadRESUMEN
PURPOSE: To analyze ultrasound features of cervical thoracic duct for patients with constrictive pericarditis and chylothorax. METHODS: Patients were retrospectively assessed. The patients were divided into a non-pleural effusion (PE) group (n = 54), a chylothorax group (n = 23), and non-chylothorax group (n = 28). Conventional ultrasound was used to obtain the maximum inner diameter and collapse of the inferior vena cava, the inner diameter of left cervical thoracic duct, and the frequency of opening of the valve at the end of the left thoracic duct. Contrast ultrasonography was used to score the reverse flow of the thoracic tube. RESULTS: The percentage of PE was 48.5%, and the percentage of chylothorax was 21.9%. The three groups had significant differences in five parameters. The inner diameter of left cervical thoracic duct was correlated with the degree of central venous pressure. Contrast ultrasonography was effective in quantitative assessment of the degree of intravenous-thoracic cord reverse flow which correlated with all parameters of central venous pressure. CONCLUSION: Thoracic duct dilation and regurgitation secondary to central venous pressure can lead to chyloreflux disorder and may be the mechanism of chylothorax occurrence in constrictive pericarditis.
Asunto(s)
Quilotórax , Pericarditis Constrictiva , Conducto Torácico , Ultrasonografía , Humanos , Pericarditis Constrictiva/diagnóstico por imagen , Pericarditis Constrictiva/complicaciones , Pericarditis Constrictiva/fisiopatología , Conducto Torácico/diagnóstico por imagen , Quilotórax/diagnóstico por imagen , Masculino , Estudios Retrospectivos , Femenino , Persona de Mediana Edad , Anciano , Ultrasonografía/métodos , AdultoRESUMEN
A pericardite constritiva (PC) é uma condição na qual a cicatrização e perda de elasticidade do pericárdio resultam em enchimento ventricular prejudicado, disfunção diastólica e insuficiência cardíaca direita. O diagnóstico dessa patologia é desafiador, sendo frequente a necessidade de técnicas de imagem multimodal, dentre as quais a ecocardiografia representa a modalidade de imagem inicial para a avaliação diagnóstica, além de permitir a diferenciação da PC da cardiomiopatia restritiva (CMR) e outras condições que mimetizam constrição. (AU)
Constrictive pericarditis (CP) is a condition in which scarring and loss of elasticity of the pericardium result in impaired ventricular filling, diastolic dysfunction, and right heart failure. The diagnosis of this pathology is challenging, with frequent need for multimodal imaging techniques, among which echocardiography represents the initial imaging modality for the diagnostic evaluation, in addition to allowing the differentiation of CP from restrictive cardiomyopathy (RCM) and other conditions that mimic constriction. (AU)
Asunto(s)
Humanos , Adolescente , Anciano , Anciano de 80 o más Años , Adulto Joven , Pericarditis Constrictiva/fisiopatología , Pericarditis Constrictiva/diagnóstico por imagen , Pericardio/anomalías , Insuficiencia Cardíaca/etiología , Pericardio/anatomía & histología , Tuberculosis/complicaciones , Cardiomiopatía Restrictiva/diagnóstico , Ecocardiografía/métodos , Espectroscopía de Resonancia Magnética/métodos , Tomografía Computarizada por Rayos X/métodosRESUMEN
Importance: Enhanced ventricular interdependence is a highly sensitive and specific criterion for the diagnosis of constrictive pericarditis (CP), but simultaneous ventricular measurements can be challenging at cardiac catheterization. Ejection times (ETs) correlate with stroke volumes and can be easily measured from arterial pressure tracings. Objective: To assess respirophasic changes in pulmonary artery (PA) ETs and aorta (Ao) ETs as a marker for enhanced ventricular interdependence. Design, Setting, and Participants: Retrospective analysis of simultaneous left-side and right-side heart catheterizations between January 2006 and January 2017 was performed. The data were analyzed in June 2020. All catheterizations were performed at the Mayo Clinic, Rochester, Minnesota. This study evaluated patients undergoing left-side and right-side heart catheterization for assessment of CP after noninvasive evaluation was inconclusive. Main Outcomes and Measures: Measurements of the PA and Ao ETs were made during inspiration and expiration. Ventricular interaction was mainly assessed by evaluating the difference of ETs from expiration to inspiration as well as the difference in Ao minus the difference in PA. Results: A total of 10 patients with surgically proven CP and 10 patients without CP (restrictive cardiomyopathy or severe tricuspid regurgitation) were identified. Of these 20 included patients, 10 (50%) were female, and the median (interquartile range) age was 59.5 (47.0-67.5) years. There were no significant differences in demographic characteristics or baseline hemodynamic measurements. In patients with CP compared with those without CP, there was a significantly greater decrease in PA ET (mean [SD], -31.8 [28.6] vs 5.1 [9.5]; P < .001) and a nonsignificantly greater increase in Ao ET (mean [SD], 19.0 [15.7] vs 10.5 [9.1]; P = 0.20) during expiration vs inspiration. Thus, the difference in Ao ET minus the difference in PA ET during expiration vs inspiration was significantly greater in those with CP compared with those without CP (mean [SD], 50.8 [22.5] milliseconds vs 5.4 [15.2] milliseconds; P < .001). Conclusions and Relevance: In this study, PA and Ao measurements of ETs throughout the respiratory cycle were a simple, easily obtainable, and accurate parameter for the diagnosis of CP.
Asunto(s)
Cateterismo Cardíaco/métodos , Ventrículos Cardíacos/diagnóstico por imagen , Pericarditis Constrictiva/diagnóstico , Volumen Sistólico/fisiología , Anciano , Femenino , Estudios de Seguimiento , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Pericarditis Constrictiva/fisiopatología , Estudios RetrospectivosRESUMEN
BACKGROUND: Constrictive pericarditis (CP) is characterized by scarring and loss of elasticity of the pericardium. This case demonstrates that mixed martial arts (MMA) is a previously unrecognized risk factor for CP, diagnosis of which is supported by cardiac imaging, right and left heart catheterization, and histological findings of dense fibrous tissue without chronic inflammation. CASE PRESENTATION: A 47-year-old Caucasian male former mixed martial arts (MMA) fighter from the Western United States presented to liver clinic for elevated liver injury tests (LIT) and a 35-pound weight loss with associated diarrhea, lower extremity edema, dyspnea on exertion, and worsening fatigue over a period of 6 months. Past medical history includes concussion, right bundle branch block, migraine headache, hypertension, chronic pain related to musculoskeletal injuries and fractures secondary to MMA competition. Involvement in MMA was extensive with an 8-year history of professional MMA competition and 13-year history of MMA fighting with recurrent trauma to the chest wall. The patient also reported a 20-year history of performance enhancing drugs including testosterone. Physical exam was notable for elevated jugular venous pressure, hepatomegaly, and trace peripheral edema. An extensive workup was performed including laboratory studies, abdominal computerized tomography, liver biopsy, echocardiogram, and cardiac magnetic resonance imaging. Finally, right and left heart catheterization-the gold standard-confirmed discordance of the right ventricle-left ventricle, consistent with constrictive physiology. Pericardiectomy was performed with histologic evidence of chronic pericarditis. The patient's hospital course was uncomplicated and he returned to NYHA functional class I. CONCLUSIONS: CP can be a sequela of recurrent pericarditis or hemorrhagic effusions and may have a delayed presentation. In cases of recurrent trauma, CP may be managed with pericardiectomy with apparent good outcome. Further studies are warranted to analyze the occurrence of CP in MMA so as to better define the risk in such adults.
Asunto(s)
Lesiones Cardíacas/etiología , Artes Marciales/lesiones , Pericarditis Constrictiva/etiología , Cateterismo Cardíaco , Electrocardiografía , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/fisiopatología , Lesiones Cardíacas/cirugía , Hemodinámica , Humanos , Imagen por Resonancia Cinemagnética , Masculino , Persona de Mediana Edad , Pericardiectomía , Pericarditis Constrictiva/diagnóstico por imagen , Pericarditis Constrictiva/fisiopatología , Pericarditis Constrictiva/cirugía , Recuperación de la Función , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Función Ventricular Izquierda , Función Ventricular DerechaRESUMEN
BACKGROUND: The operative mortality of pericardiectomy still is high. This retrospective study was conducted to determine the risk factors of early mortality and multiorgan failure. METHODS: We retrospectively analyzed patients undergoing pericardiectomy from January 2009 to June 2020 at our hospital. Pericardiectomy was performed via sternotomy. Histopathologic studies of pericardium tissue from every patient were done. All survivors were monitored to the end date of the study. RESULTS: Ninety-two consecutive patients undergoing pericardiectomy for constrictive pericarditis were included in the study. Postoperatively, central venous pressure significantly decreased, and left ventricular end diastolic dimension and left ventricular ejection fractions significantly improved. The overall mortality rate was 5.4%. The common postoperative complications include acute renal injury (27.2%), and multiorgan failure (8.7%). Analyses of risk factors showed that fluid balance of the second day following operation is associated with early mortality and multiorgan failure. In this series from Guangxi, China, characteristic histopathologic features of tuberculosis (60/92, 65.2%) of pericardium were the most common histopathologic findings, and 32 patients (32/92, 34.8%) had the histopathologic findings of chronic nonspecific inflammatory changes. The functional status of the patients improved after pericardiectomy; 6 months later postoperatively 85 survivors were in class I (85/87, 97.7%) and two were in class II (2/87, 2.3%). CONCLUSIONS: Tuberculosis is the most common cause of constrictive pericarditis in Guangxi, China. Fluid balance of the second day following operation is associated with early mortality and multiorgan failure after pericardiectomy for constrictive pericarditis in our study.
Asunto(s)
Mortalidad Hospitalaria , Insuficiencia Multiorgánica/etiología , Pericardiectomía/efectos adversos , Pericarditis Constrictiva/fisiopatología , Pericarditis Constrictiva/cirugía , Equilibrio Hidroelectrolítico , Lesión Renal Aguda/etiología , China , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pericardiectomía/métodos , Pericarditis Constrictiva/diagnóstico por imagen , Pericarditis Constrictiva/mortalidad , Complicaciones Posoperatorias , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVES: We investigated haemodynamics and clinical outcomes according to type of pulmonary hypertension (PH) in patients with constrictive pericarditis (CP). BACKGROUND: As the prevalence of CP with concomitant myocardial disease (mixed CP) grows, PH is more commonly seen in patients with CP. However, haemodynamic and outcome data according to the presence or absence of PH are limited. METHODS: 150 patients with surgically confirmed CP who underwent echocardiography and cardiac catheterisation within 7 days at two tertiary centres were divided into three groups: no-PH, isolated postcapillary PH (Ipc-PH) and combined postcapillary and precapillary PH (Cpc-PH). Primary outcome was all-cause mortality during follow-up. RESULT: In this retrospective cohort study, 110 (73.3%) had PH (mean pulmonary artery pressure ≥25 mm Hg). Cpc-PH, using defined cut-offs for pulmonary vascular resistance (>3 Wood units) or diastolic pulmonary gradient (≥7 mm Hg), was seen in 18 patients (12%). The Cpc-PH group had a higher prevalence of comorbidities (diabetes and atrial fibrillation) and concomitant myocardial disease as an aetiology of CP than other groups. Pulmonary vascular resistance had a significant direct correlation with medial E/e' by Doppler echocardiography (r=0.404, p<0.001). Survival rate was significantly lower in the Cpc-PH than the no-PH (p=0.002) and Ipc-PH (p=0.024) groups. On multivariable analysis, age, New York Heart Association functional class IV, medial e' velocity, Cpc-PH and Ipc-PH were independently associated with long-term mortality. CONCLUSION: Combined postcapillary and precapillary PH develops in a subset of patients with CP and is associated with long-term mortality after pericardiectomy.
Asunto(s)
Hipertensión Pulmonar/etiología , Pericarditis Constrictiva/complicaciones , Presión Esfenoidal Pulmonar/fisiología , Resistencia Vascular/fisiología , Cateterismo Cardíaco/métodos , Ecocardiografía Doppler , Femenino , Estudios de Seguimiento , Humanos , Hipertensión Pulmonar/epidemiología , Hipertensión Pulmonar/fisiopatología , Masculino , Persona de Mediana Edad , Pericarditis Constrictiva/diagnóstico , Pericarditis Constrictiva/fisiopatología , Estudios RetrospectivosAsunto(s)
Ecocardiografía/métodos , Ventrículos Cardíacos/fisiopatología , Imagen por Resonancia Cinemagnética/métodos , Pericarditis Constrictiva/fisiopatología , Tomografía Computarizada por Rayos X/métodos , Función Ventricular/fisiología , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Pericardiectomía , Pericarditis Constrictiva/diagnóstico , Pericarditis Constrictiva/cirugíaRESUMEN
To the best of our knowledge there are no publications about Tunisian experience in constrictive pericarditis (CP); the aim of this study was therefore to review our twenty-one years' experience in terms of clinical and surgical outcomes and risk factors of death after pericardiectomy. An analytic bicentric and retrospective study carried out on 25 patients (20 male) with CP underwent pericardiectomy, collected over a 21-years period. The mean age was 40.46±16.74 years [7.5-72]. The commonest comorbid factor was tabagism (52%). The most common etiology was tuberculosis (n = 11, 44%). Dyspnea was the most common functional symptom (n = 21, 84%). Pericardiectomy was performed in all our patients within 2.9±3.19 months after confirmation of diagnosis. It was subtotal in 96% of cases. The commonest postoperative complications are pleural effusion (20%). Dyspnea was regressed within 1.8 months in 80% of cases and clinical signs of right heart failure within a mean duration of 1.62 months in 53% of cases. Perioperative mortality was 12% (3 deaths), late mortality was 4% (1 patient). Cardiopulmonary bypass, New York Heart Association (NYHA) over class II and right ventricular dysfunction are the prognostic factors of mortality (p = 0.001, 0.046, 0.019). Tuberculosis as etiology of CP had no impact on mortality. CP is a rare disease, with non-specific clinical signs. Pericardiectomy is effective with a significant improvement of the functional status of patients and favorable outcome at short and long term nevertheless hospital mortality is not negligible and depends on many factors.
Asunto(s)
Puente Cardiopulmonar , Mortalidad Hospitalaria , Pericardiectomía/métodos , Pericarditis Constrictiva/cirugía , Complicaciones Posoperatorias/epidemiología , Adolescente , Adulto , Anciano , Puente Cardiopulmonar/efectos adversos , Puente Cardiopulmonar/métodos , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pericardiectomía/efectos adversos , Pericarditis Constrictiva/mortalidad , Pericarditis Constrictiva/fisiopatología , Complicaciones Posoperatorias/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Túnez , Adulto JovenRESUMEN
Despite the monumental advances in the diagnoses and therapeutics of malignancy, several cancer patients have presented with pericardial involvement, including acute pericarditis, constrictive pericarditis, and pericardial effusion. Multiple factors can contribute to acute pericarditis, including direct metastasis to the heart, pericardial hemorrhage, infections due to immunosuppression, and cancer therapies that include chemotherapy, immunotherapy, and radiation. Pericardial effusion, either due to cancer invasion or cancer treatment, is one of the most common incidental findings in cancer patients, which significantly worsens morbidity and mortality. If left untreated, pericardial effusion is known to cause complications such as pericardial tamponade. Constrictive pericarditis can be due to radiation exposure, chemotherapy, or is a sequela of a previous episode of acute pericarditis. In conclusion, early detection, prompt treatment, and understanding of pericardial diseases are necessary to help improve the quality of life of cancer patients, and we aim to summarize the knowledge of pericardial involvement in patients with cancer.
Asunto(s)
Antineoplásicos/efectos adversos , Hemorragia/fisiopatología , Neoplasias/terapia , Derrame Pericárdico/fisiopatología , Pericarditis Constrictiva/fisiopatología , Traumatismos por Radiación/fisiopatología , Radioterapia/efectos adversos , Hemorragia/diagnóstico , Hemorragia/etiología , Hemorragia/terapia , Humanos , Huésped Inmunocomprometido , Infecciones/etiología , Infecciones/inmunología , Infecciones/fisiopatología , Metástasis de la Neoplasia , Neoplasias/complicaciones , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiología , Derrame Pericárdico/terapia , Pericarditis/diagnóstico , Pericarditis/etiología , Pericarditis/fisiopatología , Pericarditis/terapia , Pericarditis Constrictiva/diagnóstico , Pericarditis Constrictiva/etiología , Pericarditis Constrictiva/terapia , Pericardio , Traumatismos por Radiación/diagnóstico , Traumatismos por Radiación/etiología , Traumatismos por Radiación/terapiaRESUMEN
Constrictive pericarditis is a relatively uncommon form of cardiac failure and presents due to scarring and consequent loss of the normal elasticity of the pericardial sac. This results in abnormal/limited ventricular filling and symptoms of heart failure. The aetiology is varied, from infective causes to idiopathic causes, or can manifest after cardiothoracic surgery. This case involves a 46-year-old man presenting with acute group A beta haemolytic streptococcus infection, and over the subsequent 6 months develops constrictive pericarditis due to what is believed to be a rheumatic aetiology. The patient subsequently underwent pericardiectomy and had restoration of normal filling dynamics confirmed on follow-up echocardiography. This case provides a subject matter for the review of the features of constrictive pericarditis and its investigation and management. This case is that it highlights the fact that pericarditis is not a benign condition. Emerging evidence suggests that pericarditis is due to a failure in inflammatory regulatory mechanisms, and patients suffering this condition have a preponderance to 'autoinflammation'. Pericarditis should be recognised early and treated fully with anti-inflammatory agents.
Asunto(s)
Bacteriemia/diagnóstico , Pericarditis Constrictiva/diagnóstico , Cardiopatía Reumática/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Antibacterianos/uso terapéutico , Antiestreptolisina/inmunología , Bacteriemia/complicaciones , Bacteriemia/tratamiento farmacológico , Cultivo de Sangre , Proteína C-Reactiva/inmunología , Cateterismo Cardíaco , Ceftriaxona/uso terapéutico , Electrocardiografía , Hospitalización , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pericardiectomía , Pericarditis Constrictiva/etiología , Pericarditis Constrictiva/fisiopatología , Pericarditis Constrictiva/cirugía , Combinación Piperacilina y Tazobactam/uso terapéutico , Cardiopatía Reumática/etiología , Cardiopatía Reumática/fisiopatología , Cardiopatía Reumática/cirugía , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/tratamiento farmacológico , Streptococcus pyogenes , Presión VentricularRESUMEN
BACKGROUND: Carcinoid heart disease (HD) is a rare form of valvular heart disease, the features of which have not been fully described by cardiac computed tomography (CT). METHODS: All patients with carcinoid HD that underwent cardiac CT, either preoperatively or for assessment of coronary arteries, between Apr-2006 and Dec-2019 at the Royal Free Hospital, UK, were reviewed. RESULTS: Of 32 patients with carcinoid HD, 29 (91%) had heart valve involvement. Abnormalities of the tricuspid and pulmonary valves were present in all patients, affecting all three leaflets in 23/26 (89%) unoperated patients for both valves. The aortic valve was affected in 4/29 (14%) patients and the mitral valve in 5/29 (17%). Left heart valves were affected in 6/29 (21%) patients. One patient (1/29; 3%) had all four valves affected. Severe changes with significant valvular regurgitation were seen in ≥75% of patients with tricuspid, pulmonary, and aortic valve abnormalities. Three patients had carcinoid myocardial metastases (3/32; 9%) and one patient had constrictive pericarditis (1/32; 3%). Ten patients had surgery of whom four (40%) had invasive coronary angiography preoperatively. Ten patients had a patent foramen ovale. Cardiac CT allowed an accurate assessment of damage to different leaflets/cusps, particularly of the pulmonary valve, where visualization with echocardiography was often (3/8; 38%) incomplete. CONCLUSION: Cardiac CT is a powerful tool for assessment of cardiac valve abnormalities, coronary arteries and the spatial relationship of coronary arteries with myocardial metastasis in patients with carcinoid HD, and should form part of multimodal imaging of this complex pathology.
Asunto(s)
Cardiopatía Carcinoide/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Vasos Coronarios/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Válvulas Cardíacas/diagnóstico por imagen , Tomografía Computarizada Multidetector , Pericarditis Constrictiva/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Cardiopatía Carcinoide/fisiopatología , Cardiopatía Carcinoide/cirugía , Toma de Decisiones Clínicas , Vasos Coronarios/fisiopatología , Ecocardiografía Tridimensional , Ecocardiografía Transesofágica , Femenino , Enfermedades de las Válvulas Cardíacas/fisiopatología , Enfermedades de las Válvulas Cardíacas/cirugía , Válvulas Cardíacas/fisiopatología , Válvulas Cardíacas/cirugía , Humanos , Londres , Masculino , Persona de Mediana Edad , Imagen Multimodal , Pericarditis Constrictiva/fisiopatología , Pericarditis Constrictiva/cirugía , Valor Predictivo de las Pruebas , PronósticoAsunto(s)
Coccidioidomicosis/microbiología , Pericarditis Constrictiva/microbiología , Antifúngicos/uso terapéutico , Cateterismo Cardíaco , Coccidioidomicosis/complicaciones , Coccidioidomicosis/diagnóstico , Coccidioidomicosis/fisiopatología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pericardiectomía , Pericarditis Constrictiva/diagnóstico , Pericarditis Constrictiva/fisiopatología , Pericarditis Constrictiva/terapia , Resultado del TratamientoRESUMEN
OBJECTIVE: Frequent flares of pericardial inflammation in recurrent or incessant pericarditis with corticosteroid dependence and colchicine resistance may represent a risk factor for constrictive pericarditis (CP). This study was aimed at the identification of CP in these patients, evaluating the efficacy and safety of anakinra, a third-line treatment based on interleukin-1 inhibition, to treat CP and prevent the need for pericardiectomy. METHODS: Consecutive patients with recurrent or incessant pericarditis with corticosteroid dependence and colchicine resistance were included in a prospective cohort study from 2015 to 2018. Enrolled patients received anakinra 100 mg once daily subcutaneously. The primary end point was the occurrence of CP. A clinical and echocardiographic follow-up was performed at 1, 3, 6 months and then every 6 months. RESULTS: Thirty-nine patients (mean age 42 years, 67% females) were assessed, with a baseline recurrence rate of 2.76 flares/patient-year and a median disease duration of 12 months (IQR 9-20). During follow-up, CP was diagnosed in 8/39 (20%) patients. After anakinra dose of 100 mg/day, 5 patients (63%) had a complete resolution of pericardial constriction within a median of 1.2 months (IQR 1-4). In other three patients (37%), CP became chronic, requiring pericardiectomy within a median of 2.8 months (IQR 2-5). CP occurred in 11 patients (28%) with incessant course, which was associated with an increased risk of CP over time (HR for CP 30.6, 95% CI 3.69 to 253.09). CONCLUSIONS: In patients with recurrent or incessant pericarditis, anakinra may have a role in CP reversal. The risk of CP is associated with incessant rather than recurrent course.
Asunto(s)
Antiinflamatorios/uso terapéutico , Proteína Antagonista del Receptor de Interleucina 1/uso terapéutico , Pericarditis Constrictiva/tratamiento farmacológico , Pericarditis/tratamiento farmacológico , Adulto , Antiinflamatorios/efectos adversos , Ecocardiografía , Femenino , Humanos , Proteína Antagonista del Receptor de Interleucina 1/efectos adversos , Masculino , Persona de Mediana Edad , Pericarditis/diagnóstico por imagen , Pericarditis/fisiopatología , Pericarditis Constrictiva/diagnóstico por imagen , Pericarditis Constrictiva/fisiopatología , Estudios Prospectivos , Recurrencia , Inducción de Remisión , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Lupus Eritematoso Sistémico/complicaciones , Pericarditis Constrictiva/etiología , Antiinflamatorios/uso terapéutico , Disnea/etiología , Humanos , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Pericardiectomía , Pericarditis Constrictiva/diagnóstico por imagen , Pericarditis Constrictiva/fisiopatología , Pericarditis Constrictiva/cirugía , Derrame Pleural/etiología , Índice de Severidad de la Enfermedad , Esteroides/uso terapéutico , Resultado del TratamientoRESUMEN
BACKGROUND: Constrictive pericarditis is easily overlooked and can lead to severe problems in hemodynamics and end-organ perfusion, in our patient leading to 98 days of anuria after living kidney transplantation. This was completely reversible after pericardectomy. CASE PRESENTATION: A 43-year-old female caucasian patient received a living kidney donation from her mother. She had developed end-stage renal disease 2 years prior due to nephrotic syndrome linked to graft-versus-host disease after allogenic stem-cell transplantation for aplastic anemia. The graft showed insufficient function already in the early postoperative phase. Dialysis was paused after surgery, but the patient developed hypervolemia with ascites and edema in the lower extremities. Doppler ultrasonography showed scarce perfusion, with intrarenal arterial waveforms without end-diastolic flow. The venous perfusion profiles showed pulsatile retrograde flow. There was no identifiable reason for a primary vascular perfusion problem on ultrasonography or transplant kidney angiography. Kidney transplant biopsy revealed no rejection but extensive acute tubular necrosis. Three weeks after transplantation, the patient developed an acute anuric graft failure caused by severe cardiac decompensation. Echocardiography revealed a previously unnoticed constrictive pericarditis, which could be confirmed in a cardio computed tomography scan. The constrictive pericarditis had not been apparent on previous x-rays, computed tomography scans, or echocardiographies, including those for transplantation evaluation. Conservative management of the constrictive pericarditis was not successful and the graft remained anuric. Eventually, the patient underwent pericardectomy 16 weeks after kidney transplantation. Shortly after surgery, the graft started urine production again, which significantly increased within a few days. The clearance improved and 2 weeks later, the patient was free from dialysis. CONCLUSIONS: This case illustrates that special attention should be given to the pericardium during transplant evaluation, especially for patients who previously underwent stem-cell transplantations, chemotherapy or radiation.
Asunto(s)
Anuria/fisiopatología , Funcionamiento Retardado del Injerto/fisiopatología , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Pericardiectomía , Pericarditis Constrictiva/cirugía , Adulto , Anemia Aplásica/terapia , Femenino , Enfermedad Injerto contra Huésped/complicaciones , Trasplante de Células Madre Hematopoyéticas , Humanos , Fallo Renal Crónico/etiología , Pericarditis Constrictiva/fisiopatologíaRESUMEN
OBJECTIVES: The efficacy of pulse index contour continuous cardiac output (PiCCO) monitoring in patients with constrictive pericarditis undergoing pericardiectomy remains unclear. The goal of this study was to explore whether PiCCO monitoring could improve clinical outcomes in these patients. METHODS: We retrospectively studied 74 patients with constrictive pericarditis undergoing pericardiectomy and assigned them to a PiCCO group and a control group. Postoperative and survival outcomes were compared between the 2 groups. RESULTS: There were 33 (44.6%) cases in the PiCCO group and 41 (55.4%) cases in the control group. The baseline characteristics were comparable between the 2 groups. In comparison to the control group, the PiCCO group showed more intraoperative fluid infusion (P = 0.003), higher postoperative central venous pressure (P = 0.007) and lower levels of postoperative brain natriuretic peptide (P = 0.021). The incidence of postoperative complications (P = 0.004) including cardiac complications (P = 0.033) was also lower in the PiCCO group. Despite no difference in survival outcomes, duration of chest drainage (P = 0.032), length of stay in the intensive care unit (P < 0.001) and the postoperative hospital stay (P = 0.044) were significantly shorter in the PiCCO group. CONCLUSIONS: This study confirmed the clinical significance of PiCCO monitoring in the enhanced recovery of patients with constrictive pericarditis undergoing pericardiectomy and provided new evidence for applying PiCCO monitoring in these patients.
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Gasto Cardíaco/fisiología , Frecuencia Cardíaca/fisiología , Unidades de Cuidados Intensivos , Monitoreo Fisiológico/métodos , Pericardiectomía/métodos , Pericarditis Constrictiva/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Pericarditis Constrictiva/fisiopatología , Estudios Retrospectivos , Adulto JovenRESUMEN
We hypothesized that tricuspid valve regurgitation was associated with increased risk of mortality after pericardiectomy for constrictive pericarditis. We reviewed the records of 518 patients who received pericardiectomy for constrictive pericarditis between January 2000 and December 2016. We excluded cases of radiation induced constrictive pericarditis, tuberculous-related constrictive pericarditis, and concomitant tricuspid valve intervention. Patients were classified according to preoperative transthoracic echocardiography tricuspid regurgitation grade: none/trivial in 276 (53%) patients, mild in 191 (37%), and moderate/severe in 51 (10%). A multivariable Cox proportional hazards regression model was used to determine an association between tricuspid valve regurgitation grade and mortality. Primary endpoint of this study was mortality. Median patient age was 62 years (interquartile range 51-69), sex was male in 409 (79%) patients, and left ventricular ejection fraction was 60% (54-65). Clinical follow-up was obtained in all patients at a median of 7.6 years (3.6-11.3). Kaplan-Meier estimates of mortality were 10.6% at 1 year, 23.5% at 5 years, and 39.0% at 10 years. Multivariable analysis demonstrated increased mortality risk with mild tricuspid valve regurgitation vs none/trivial (hazard ratio 1.64; 95% confidence interval 1.11-2.43; Pâ¯=â¯0.012) and moderate/severe tricuspid valve regurgitation vs none/trivial (hazard ratio 2.27; 95% confidence interval 1.39-3.69; Pâ¯=â¯0.001). These findings were independent of right ventricular function. Tricuspid valve regurgitation is a common and clinically important comorbidity in patients operated with pericardiectomy for constrictive pericarditis. Mild or greater tricuspid valve regurgitation is associated with an increased risk of mortality following operation.