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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2016, Vol. 10 Issue (3) : 356-359     DOI: 10.1007/s11684-016-0467-6
CASE REPORT |
A rare chronic constrictive pericarditis with localized adherent visceral pericardium and normal parietal pericardium: a case report
Qingqiang Ni2,Lin Yun3,Rui Xu1,*(),Guohua Li1,Yucai Yao1,Jiamin Li1
1. Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China
2. Medical College of Soochow University, Suzhou 215123, China
3. Department of Medicine, Jinan Maternity and Child Care Hospital, Jinan 250001, China
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Abstract  

Classic constrictive pericarditis (CP) is characterized by fibrous scarring and adhesion of both the visceral pericardium and the parietal pericardium, which leads to restricted cardiac filling. However, diagnosing CP with normal thickness pericardium and without calcification is still a challenge. The predominant cause in the developed world is idiopathic or viral pericarditis, followed by post-cardiac surgery and post-radiation. Tuberculosis still remains a common cause of CP in developing countries. In this report, we describe a rare case of idiopathic localized constrictive visceral pericardium with normal thickness of the parietal pericardium in a middle-aged man. The patient presented with unexplained right heart failure and echocardiography showed moderate bi-atrial enlargement which should be?identified with the restrictive cardiomyopathy.?After 10 months of conservative treatment, the progression of right heart failure was remaining. A pericardiectomy was performed and the patient recovered. This case serves as a reminder to consider CP in patients with unexplained right heart failure, so that timely investigation and treatment can be initiated.

Keywords constrictive pericarditis      heart failure      pericardiectomy     
Corresponding Authors: Rui Xu   
Just Accepted Date: 21 July 2016   Online First Date: 12 August 2016    Issue Date: 30 August 2016
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-016-0467-6     OR     http://academic.hep.com.cn/fmd/EN/Y2016/V10/I3/356
References Year Patient Pericardium Characteristic Therapy Prognosis
Age (year) Sex Calcified Thickened
Lambelin et al. [2] 2014 55 M Yes NM Pheochromocytoma Subtotal pericardectomy Recovery
Kushida et al. [3] 2014 61 F NM NM Neoplastic constrictive pericarditis Chemotherapy Death
Samara et al. [4] 2010 66 F NM Yes Transient, pericardial constriction Steroid treatment Recovery
Nachimuthu et al. [5] 2009 54 M Yes NM Gitelman’s syndrome Pericardectomy Improved
Tugcu et al. [6] 2008 77 M Yes Yes Narrowing the ascending aorta Pericardectomy Improved
Godoy et al. [7] 2007 55 M NM Yes Voluminous ascitis Pericardectomy Improved
Yamauchi et al. [8] 2007 58 F Yes Yes Large mediastinal tumor Pericardectomy Improved
Al-Sarraf et al. [9] 2007 73 M Yes NM Pericardial hematoma Pericardectomy Death
Akhter et al. [10] 2006 40 F No Yes Thorough physical examination Pericardectomy Improved
Barbieri et al. [11] 2004 28 M NM Yes Transient, acute, healthy young man Nonsteroidal anti-inflammatory drugs Recovery
Chien et al. [12] 2003 16 M Yes Yes Pulmonary stenosis Pericardectomy Recovery
Lim et al. [13] 2002 46 F Yes Yes Recurrent cardiac failure Pericardectomy Improved
Tab.1  Previous case reports of idiopathic constrictive pericarditis (published in English)
Fig.1  (A) Echocardiography showed biatrial enlargement. The ventricles were deformed; the intermediate part of left and right ventricles was narrower than the cardiac apex. (B) The shape of the ventricles was almost normal after pericardiectomy.
Fig.2  (A) MRI showed a narrow, tubular deformation of the lower bi-ventricular that coincided with the echocardiography findings. The thickness of the pericardium was normal and calcification was not observed. (B) CT revealed gourd-shaped ventricles. The pericardium thickness was normal. CT, computed tomography; MRI, magnetic resonance imaging.
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