Persistence of constrictive pattern despite improvement in symptoms after the waffle procedure: A case report of constrictive pericarditis
Persistence of constrictive pattern despite improvement in symptoms after the waffle procedure: A case report of constrictive pericarditis
复制标题
尽管华夫饼手术后症状有所改善，但缩窄性模式持续存在：缩窄性心包炎的病例报告
DOI：
10.1016/j.jccase.2020.04.008
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发表时间：
2020
影响因子：
--
通讯作者：
Kawamoto Shunsuke
中科院分区：
文献类型：
--
作者：
Minagawa Tadanori;Ohara Takahiro;Hasegawa Kaoru;Takeda Miki;Hiranuma Wakiko;Matsuoka Takayuki;Shimizu Takuya;Watanabe Suguru;Kawamoto Shunsuke
缩窄性心包炎是一种少见的疾病，其特征是心包顺应性丧失后出现右侧心力衰竭的临床体征。虽然心包切除术是改善CP心脏血流动力学的公认治疗方法，但有些患者在心包切除术后未能改善。我们在此报告一例慢性前列腺炎，表现出一些物理和血流动力学特征，尽管心包切除术后心力衰竭症状有所改善，但仍存在收缩模式。一名61岁的男子被诊断为CP 7个月后出现的症状，呼吸急促和水肿的腿。使用超声刀进行华夫程序。术后心导管检查显示右心室（RV）和左心室（LV）压力均呈下降和平台模式，但RV和LV舒张末期压力改善。此外，多普勒超声心动图显示二尖瓣和三尖瓣早期速度随呼吸的变化有所改善。术中右心房压力降低以及超声心动图显示的左心室和右心室流入的呼吸变异性是术后心力衰竭症状改善的重要预测因素。学习目的：即使缩窄性心包炎的某些血流动力学特征（倾斜和平台模式，Friedreich征）持续存在，术中右心房压力降低以及术后超声心动图显示的左心室和右心室流入的呼吸变异性也是心力衰竭症状改善的重要预测因素。>
Constrictive pericarditis (CP) is an uncommon disease characterized by clinical signs of right-sided heart failure subsequent to loss of pericardial compliance. Although pericardiectomy is the accepted treatment for improving cardiac hemodynamics in CP, some patients fail to improve after pericardiectomy. We herein report a case of CP that showed some physical and hemodynamic features with a constrictive pattern that persisted despite the improvement in heart failure symptoms after pericardiectomy. A 61-year-old man was diagnosed with CP 7 months after the onset of symptoms of shortness of breath and edema in the legs. The waffle procedure was performed using an ultrasonic scalpel. Post-operative cardiac catheterization demonstrated a dip-and-plateau pattern in both right ventricular (RV) and left ventricular (LV) pressures, but the RV and LV end-diastolic pressures improved. Moreover, Doppler echocardiography showed an improvement in the change in mitral and tricuspid early velocities with respiration. Decrease in intraoperative right atrial pressure and respiratory variability in LV and RV inflow on echocardiography are important predictors of improvement in post-operative heart failure symptoms.Learning objective:Decrease in intraoperative right atrial pressure and respiratory variability in left ventricular and right ventricular inflow on post-operative echocardiography are important predictors of improvement in heart failure symptoms even if some hemodynamic features characterizing constrictive pericarditis (dip and plateau pattern, Friedreich's sign) persist.>