Sagristà-Sauleda Jaume, Angel Juan, Sánchez Antonio, Permanyer-Miralda Gaietà, Soler-Soler Jordi
Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
N Engl J Med. 2004 Jan 29;350(5):469-75. doi: 10.1056/NEJMoa035630.
Effusive-constrictive pericarditis is an uncommon pericardial syndrome characterized by concomitant tamponade, caused by tense pericardial effusion, and constriction, caused by the visceral pericardium. We conducted a prospective study of its clinical evolution and management.
From 1986 through 2001, all patients with effusive-constrictive pericarditis were prospectively evaluated. Combined pericardiocentesis and cardiac catheterization were performed in all patients, and pericardiectomy was performed in those with persistent constriction. Follow-up ranged from 1 month to 15 years (median, 7 years).
A total of 1184 patients with pericarditis were evaluated, 218 of whom had tamponade. Of these 218, 190 underwent combined pericardiocentesis and catheterization. Fifteen of these patients had effusive-constrictive pericarditis and were included in the study. All patients presented with clinical tamponade; however, concomitant constriction was recognized in only seven patients. At catheterization, all patients had elevated intrapericardial pressure (median, 12 mm Hg; interquartile range, 7 to 18) and elevated right atrial and end-diastolic right and left ventricular pressures. After pericardiocentesis, the intrapericardial pressure decreased (median value, -5 mm Hg; interquartile range, -5 to 0), whereas right atrial and end-diastolic right and left ventricular pressures, although slightly reduced, remained elevated, with a dip-plateau morphology. The causes were diverse, and death was mainly related to the underlying disease. Pericardiectomy was required in seven patients, all of whom had involvement of the visceral pericardium. Three patients had spontaneous resolution.
Effusive-constrictive pericarditis is an uncommon pericardial syndrome that may be missed in some patients who present with tamponade. Although evolution to persistent constriction is frequent, idiopathic cases may resolve spontaneously. In our opinion, extensive epicardiectomy is the procedure of choice in patients requiring surgery.
渗出性缩窄性心包炎是一种罕见的心包综合征，其特征为同时存在由紧张的心包积液引起的心脏压塞和由脏层心包引起的缩窄。我们对其临床演变和治疗进行了一项前瞻性研究。
从1986年至2001年，对所有渗出性缩窄性心包炎患者进行前瞻性评估。所有患者均接受心包穿刺术和心导管检查，对持续缩窄的患者进行心包切除术。随访时间为1个月至15年（中位数为7年）。
共评估了1184例心包炎患者，其中218例有心脏压塞。在这218例患者中，190例接受了心包穿刺术和导管检查。这些患者中有15例患有渗出性缩窄性心包炎并被纳入研究。所有患者均表现为临床心脏压塞；然而，只有7例患者同时存在缩窄。在心导管检查时，所有患者的心包内压力均升高（中位数为12 mmHg；四分位间距为7至18），右心房及右、左心室舒张末期压力升高。心包穿刺术后，心包内压力下降（中位数为-5 mmHg；四分位间距为-5至0），而右心房及右、左心室舒张末期压力虽略有降低，但仍升高，呈下陷-高原形态。病因多种多样，死亡主要与基础疾病有关。7例患者需要进行心包切除术，所有这些患者的脏层心包均受累。3例患者自发缓解。
渗出性缩窄性心包炎是一种罕见的心包综合征，在一些表现为心脏压塞的患者中可能被漏诊。虽然演变为持续性缩窄很常见，但特发性病例可能自发缓解。我们认为，对于需要手术的患者，广泛的心外膜切除术是首选手术方式。
