Severe pulmonary regurgitation mimicking constrictive pericarditis: a case report—the sac or the content? That is the question
| Autor: | Ken-ichi Hirata, Hidekazu Tanaka, Kensuke Matsumoto, Makiko Suto |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Constrictive pericarditis
medicine.medical_specialty Pericardial constriction Pulmonary regurgitation Case Reports 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Internal medicine Case report medicine Pericardium 030212 general & internal medicine Heart Failure business.industry medicine.disease Right-sided heart failure medicine.anatomical_structure Blood pressure Constrictive physiology Heart failure Ventricular pressure Cardiology cardiovascular system Elevated right atrial pressure Pulmonary Valve Insufficiency Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Heart Journal: Case Reports |
| ISSN: | 2514-2119 |
| Popis: | Background Constrictive pericarditis (CP) is a pathological condition of the pericardium, resulting from fibrosis, scarring, and calcification of the pericardium. Other conditions have been reported to mimic ‘constrictive physiology’ despite the presence of an intact pericardium. However, there has been no report of pulmonary regurgitation (PR) mimicking the haemodynamic characteristics of CP. Case summary A 51-year-old woman was admitted to our institute because of severe right-sided heart failure. Transthoracic echocardiography revealed severe PR concomitant with significant dilatation of the right-sided heart. Septal bounce and the respiratory reciprocation of the transmitral and transtricuspid inflow velocities were also observed, indicating exacerbated ventricular interdependence. Cardiac catheter examination demonstrated elevated right atrial pressure with a prominent y descent, dip, and plateau waveform in the right ventricular pressure, and equalization of the diastolic pressure of all cardiac chambers, which are quite consistent with CP. On surgical inspection, however, there was no pericardial thickening or adhesion, indicating no obvious signs of CP. Discussion Pericardial constriction results from the relative relationship between intrapericardial volume and pericardial reserve. When the intrapericardial volume exceeds the physiological limit, the cardiac chambers compete with each other in a fixed pericardial space. In this case, prominent dilation of the right-sided chambers caused by severe PR resulted in overstretching of the pericardium above the pericardial reserve, which led to a characteristic haemodynamic picture that resembled CP. Thus, it is important to recognize the diagnostic pitfall in the preoperative evaluation of a ‘CP mimic physiology’. |
| Databáze: | OpenAIRE |
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