Mehta A, Mehta M, Jain A C
Department of Medicine, West Virginia University School of Medicine, Morgantown, USA.
Clin Cardiol. 1999 May;22(5):334-44. doi: 10.1002/clc.4960220509.
The diagnosis of constrictive pericarditis remains a challenge because its physical findings and hemodynamics mimic restrictive cardiomyopathy. Various diagnostic advances over the years enable us to differentiate between these two conditions. This review begins with a case report of constrictive pericarditis, followed by a brief history and discussions of etiologies. Clinical features, radiologic, electrocardiographic, angiographic findings, and hemodynamics of constrictive pericarditis are reviewed. The echocardiographic findings are detailed and the recent advances in Doppler flow velocity patterns of pulmonary, mitral, tricuspid valves and hepatic veins are reported. Nuclear ventriculograms depict rapid ventricular filling in constrictive pericarditis and differentiate it from restrictive cardiomyopathy. Endomyocardial biopsy helps further in recognizing the various types of restrictive cardiomyopathies. Computed tomography and magnetic resonance imaging delineate abnormal pericardial thickness in constrictive pericarditis. Association of characteristic hemodynamic changes and abnormal pericardial thickness > 3 mm usually confirms the diagnosis of constrictive pericarditis. Effusive and occult varieties of constrictive pericarditis are briefly described. This review concludes with emphasizing the importance of pericardial resection.
缩窄性心包炎的诊断仍然是一项挑战，因为其体格检查结果和血流动力学表现与限制型心肌病相似。多年来的各种诊断进展使我们能够区分这两种疾病。本文首先报告一例缩窄性心包炎病例，随后简述其病史并讨论病因。本文回顾了缩窄性心包炎的临床特征、放射学、心电图、血管造影表现及血流动力学。详细阐述了超声心动图表现，并报告了肺、二尖瓣、三尖瓣及肝静脉多普勒流速模式的最新进展。核素心室造影显示缩窄性心包炎时心室快速充盈，并将其与限制型心肌病区分开来。心内膜心肌活检有助于进一步识别各种类型的限制型心肌病。计算机断层扫描和磁共振成像可显示缩窄性心包炎心包厚度异常。特征性血流动力学改变与心包厚度>3mm异常通常可确诊缩窄性心包炎。简要描述了缩窄性心包炎的渗出型和隐匿型。本文最后强调了心包切除术的重要性。
