Cacoub P, Wechsler B, Chapelon C, Gandjbakhch I, Blétry O, Piette J C, Cabrol C, Godeau P
Service de Médecine interne, Groupe hospitalier Pitié-Salpêtrière, Paris.
Presse Med. 1991 Dec 14;20(43):2185-90.
Twenty-seven cases of chronic constrictive pericarditis seen between 1975 and 1990 in an internal medicine department were analyzed retrospectively. The chronic pericarditis was consecutive to one (n = 5) or several (n = 7) episodes of acute pericarditis. Echography demonstrated the presence of pericardial effusion in 74 percent of the cases, pericardial thickening in 41 percent and/or compression of right heart cavities in 55 percent. Computerized tomography of the chest, performed in 16 cases, showed pericardial effusion in 63 percent of the cases, pericardial thickening in 37 percent and lymph node enlargement in 19 percent. Magnetic resonance imaging of the chest was carried out in 2 patients but showed no abnormality. All 11 patients who underwent cardiac catheterization were found to be adiastolic. The cause of constrictive pericarditis, elicited in 13 patients was neoplasia in 4, sequelae of radiotherapy in 2, injuries in 2, mediastinal and retroperitoneal fibrosis in 2, myocardial infarction in 1, purulent pericarditis in 1 and bacteriologically proven tuberculosis in 1. Medical treatment with corticosteroids (n = 16) and/or antituberculous therapy (n = 15) was successful in 2 patients; 25 patients had to undergo surgery 7 +/- 11 months after constriction was diagnosed. Pericardial drainage (through a pericardiopleural window in 4 cases) proved to be sufficient in 10/15 patients but failed in 5. Pericardectomy was performed initially in 3 cases and after failure of medical treatment and/or drainage in 11 cases. The 4 patients with neoplastic constrictive pericarditis died 10 months on average after the diagnosis, but the remaining 23 patients were alive after à 9 to 48 months (mean: 19 +/- 15) follow-up. These results suggest that the data provided by echocardiography and computerized tomography of the chest usually point to the relevant therapeutic measures without a need for invasive haemodynamic exploration. Idiopathic constrictive pericarditis now accounts for 50 percent of the cases; tuberculosis has become exceptional, but the other, previously exceptional causes (neoplasia, heart surgery, radiotherapy, connective tissue diseases) are more frequent. Corticosteroids should be used in chronic constrictive pericarditis occurring after cardiac surgery or in the course of a connective tissue disease, but they are effective only in highly inflammatory forms of the disease. Modern treatment relies on early surgery, since functional results and patient's survival are closely related to the date of pericardectomy which must be carried out before very important myocardial repercussions develop.
回顾性分析了1975年至1990年间内科收治的27例慢性缩窄性心包炎患者。慢性心包炎继发于1次（n = 5）或数次（n = 7）急性心包炎发作之后。超声心动图显示，74%的病例存在心包积液，41%的病例有心包增厚，和/或55%的病例有右心腔受压。16例患者进行了胸部计算机断层扫描，63%的病例显示有心包积液，37%的病例有心包增厚，19%的病例有淋巴结肿大。2例患者进行了胸部磁共振成像检查，但未发现异常。所有11例行心导管检查的患者均显示舒张功能异常。13例患者缩窄性心包炎的病因中，4例为肿瘤，2例为放疗后遗症，2例为损伤，2例为纵隔和腹膜后纤维化，1例为心肌梗死，1例为化脓性心包炎，1例为细菌学证实的结核。使用皮质类固醇（n = 16）和/或抗结核治疗（n = 15），2例患者治疗成功；25例患者在诊断缩窄后7±11个月接受了手术。心包引流（4例通过心包胸膜开窗引流）在15例患者中有10例有效，但5例失败。3例患者最初进行了心包切除术，11例患者在药物治疗和/或引流失败后进行了心包切除术。4例肿瘤性缩窄性心包炎患者在诊断后平均10个月死亡，但其余23例患者在9至48个月（平均：19±15）的随访后仍存活。这些结果表明，超声心动图和胸部计算机断层扫描提供的数据通常能指明相关治疗措施，无需进行有创血流动力学检查。特发性缩窄性心包炎目前占病例的50%；结核已变得罕见，但其他先前罕见的病因（肿瘤、心脏手术、放疗、结缔组织病）更为常见。皮质类固醇应用于心脏手术后发生的或结缔组织病过程中的慢性缩窄性心包炎，但仅对疾病的高度炎症形式有效。现代治疗依赖早期手术，因为功能结果和患者生存率与心包切除术的时机密切相关，心包切除术必须在出现非常重要的心肌影响之前进行。
