Hirata K, Asato H, Maeshiro M
Division of Cardiology, Okinawa Chuba Hospital, Japan.
Jpn Circ J. 1991 Feb;55(2):154-8. doi: 10.1253/jcj.55.154.
A 55-year-old male presented with hypotension and marked elevation of jugular venous pressure suggesting impaired ventricular filling. Echocardiography demonstrated a moderate amount of pericardial effusion and dense and shaggy fibrinous strands attached to the pericardia. Pericardiocentesis was performed under the diagnosis of cardiac tamponade, but normal ventricular filling could not be restored even after pericardiocentesis. Hemodynamic evaluation after pericardiocentesis revealed persisting low cardiac output, elevation and equilibration of right atrial, right ventricular end-diastolic and pulmonary capillary wedge pressures, and deep y descent. Later, surgical removal of the thickened pericardium was required. This case appeared to be typical effusive-constrictive pericarditis. Regarding etiology, a rare organism, Streptococcus milleri, proved to be responsible, while the case history and clinical situation were suggestive of a tuberculous or tumorous origin.
一名55岁男性因低血压和颈静脉压显著升高就诊，提示心室充盈受损。超声心动图显示中等量心包积液，心包上附着致密且呈绒毛状的纤维条索。在诊断为心脏压塞后进行了心包穿刺，但即使心包穿刺后仍无法恢复正常的心室充盈。心包穿刺后的血流动力学评估显示心输出量持续降低，右心房、右心室舒张末期及肺毛细血管楔压升高且趋于平衡，以及y降支加深。随后，需要手术切除增厚的心包。该病例似乎是典型的渗出性缩窄性心包炎。关于病因，一种罕见的微生物——米勒链球菌被证实为病因，而病史和临床情况提示为结核或肿瘤起源。
