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Severe pulmonary regurgitation mimicking constrictive pericarditis: a case report-the sac or the content? That is the question.
Eur Heart J Case Rep. 2020 Jun; 4(3):1-5.EH

Abstract

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'.

Authors+Show Affiliations

Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32617479

Citation

Suto, Makiko, et al. "Severe Pulmonary Regurgitation Mimicking Constrictive Pericarditis: a Case Report-the Sac or the Content? That Is the Question." European Heart Journal. Case Reports, vol. 4, no. 3, 2020, pp. 1-5.
Suto M, Matsumoto K, Tanaka H, et al. Severe pulmonary regurgitation mimicking constrictive pericarditis: a case report-the sac or the content? That is the question. Eur Heart J Case Rep. 2020;4(3):1-5.
Suto, M., Matsumoto, K., Tanaka, H., & Hirata, K. I. (2020). Severe pulmonary regurgitation mimicking constrictive pericarditis: a case report-the sac or the content? That is the question. European Heart Journal. Case Reports, 4(3), 1-5. https://doi.org/10.1093/ehjcr/ytaa090
Suto M, et al. Severe Pulmonary Regurgitation Mimicking Constrictive Pericarditis: a Case Report-the Sac or the Content? That Is the Question. Eur Heart J Case Rep. 2020;4(3):1-5. PubMed PMID: 32617479.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Severe pulmonary regurgitation mimicking constrictive pericarditis: a case report-the sac or the content? That is the question. AU - Suto,Makiko, AU - Matsumoto,Kensuke, AU - Tanaka,Hidekazu, AU - Hirata,Ken-Ichi, Y1 - 2020/04/27/ PY - 2019/12/22/received PY - 2020/01/22/revised PY - 2020/03/26/accepted PY - 2020/7/4/entrez PY - 2020/7/4/pubmed PY - 2020/7/4/medline KW - Case report KW - Constrictive pericarditis KW - Constrictive physiology KW - Pulmonary regurgitation KW - Right-sided heart failure SP - 1 EP - 5 JF - European heart journal. Case reports JO - Eur Heart J Case Rep VL - 4 IS - 3 N2 - 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'. SN - 2514-2119 UR - https://www.unboundmedicine.com/medline/citation/32617479/Severe_pulmonary_regurgitation_mimicking_constrictive_pericarditis:_a_case_report-the_sac_or_the_content_That_is_the_question DB - PRIME DP - Unbound Medicine ER -
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