Sengupta Partho P, Eleid Mackram F, Khandheria Bijoy K
Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, USA.
Circ J. 2008 Oct;72(10):1555-62. doi: 10.1253/circj.cj-08-0654. Epub 2008 Sep 2.
Constrictive pericarditis (CP) is characterized by scarring and loss of elasticity of the pericardium, resulting in external impedance of cardiac filling. In the developed world, CP is most frequently encountered as a consequence of previous cardiac surgery, thoracic irradiation, viral or idiopathic causes. Tuberculosis still remains a common cause of CP in the developing world, immigrants from underdeveloped nations, and immunosuppressed patients. Clinical signs and symptoms of right heart failure coupled with risk factors for pericardial disease should raise suspicion for CP. Echocardiographic evaluation and often cardiac catheterization are essential components of accurate diagnosis of CP. Enhanced interventricular dependence, with respiratory variation in the ventricular pressures, and ventricular discordance are the pathophysiologic hallmarks of CP. Imaging findings such as increased pericardial thickness or pericardial calcification on computed tomography can be supportive, but are not necessary for the diagnosis of CP. Pericardiectomy remains the most effective therapy for symptomatic CP.
缩窄性心包炎（CP）的特征是心包瘢痕形成和弹性丧失，导致心脏充盈的外部阻抗。在发达国家，CP最常见的病因是既往心脏手术、胸部放疗、病毒感染或特发性病因。在发展中国家、来自不发达国家的移民以及免疫抑制患者中，结核病仍然是CP的常见病因。右心衰竭的临床体征和症状以及心包疾病的危险因素应引起对CP的怀疑。超声心动图评估以及通常的心脏导管检查是CP准确诊断的重要组成部分。心室间依赖性增强，伴有心室压力的呼吸变化以及心室不协调是CP的病理生理特征。计算机断层扫描上的心包厚度增加或心包钙化等影像学表现可作为支持，但对于CP的诊断并非必需。心包切除术仍然是有症状CP最有效的治疗方法。
