Payvandi M N, Kerber R E
Circulation. 1976 Jan;53(1):86-92. doi: 10.1161/01.cir.53.1.86.
The purpose of this study was to investigate the echocardiographic effects of absence of the pericardium. Five patients with congenital complete absence of the left pericardium were studied. All had typical chest X-rays, four had cardiac catheterization which excluded any intracardiac shunts, and one had diagnostic pneumothorax. All five had an enlarged right ventricular dimension (RVD): 1.9 +/- 0.1 cm/m2 (normal: less than 1.3 cm/m2) and abnormal interventricular septal (IVS) motion (three Type A, two Type B). Sixteen additional patients were studied after pericardial stripping for a variety of conditions. In none was cardiopulmonary bypass used. Eight of these patients had preoperative echocardiograms; all showed normal IVS motion. After surgery RVD was large in all 16 patients, increasing from 1.0 +/- 0.2 cm/m2 preoperatively to 1.7 +/- 0.1 cm/m2 postoperatively, P less than 0.01. Fourteen of the 16 patients had abnormal IVS motion, nine Type A, and five Type B. We conclude that absence of the pericardium results in echocardiographic abnormalities which mimic those seen in right ventricular volume overload. This may be due to altered cardiac position and motion within the thorax resulting from loss of normal pericardial restraint.
本研究的目的是探讨心包缺如的超声心动图表现。对5例先天性左心包完全缺如的患者进行了研究。所有患者胸部X线表现均典型，4例接受了心导管检查，排除了任何心内分流，1例进行了诊断性气胸检查。所有5例患者右心室径（RVD）均增大：1.9±0.1cm/m²（正常：小于1.3cm/m²），室间隔（IVS）运动异常（3例A型，2例B型）。另外16例因各种情况接受心包剥脱术的患者也进行了研究。均未使用体外循环。其中8例患者术前有超声心动图检查；所有结果均显示IVS运动正常。术后所有16例患者的RVD均增大，从术前的1.0±0.2cm/m²增加到术后的1.7±0.1cm/m²，P<0.01。16例患者中有14例IVS运动异常，9例A型，5例B型。我们得出结论，心包缺如会导致超声心动图异常，类似于右心室容量超负荷时所见。这可能是由于正常心包约束丧失导致心脏在胸腔内的位置和运动发生改变所致。
