Ostad Karampour Saman, Sedlak Tara L, Luong Christina L, Price Joel E, Brunner Nathan W
Division of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9.
Division of Cardiology, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9.
Eur Heart J Case Rep. 2022 Jul 2;6(7):ytac272. doi: 10.1093/ehjcr/ytac272. eCollection 2022 Jul.
Constrictive pericarditis (CP) is a rare condition in which the pericardium becomes progressively fibrotic and non-compliant leading to impaired ventricular filling and overt heart failure. While CP shares many clinical and haemodynamic similarities with restrictive cardiomyopathy, differentiation of these diseases is crucial as CP is potentially curative through pericardiectomy. Here, we present a case of proven pericardial constriction with atypical haemodynamics in a patient presenting with heart failure and severe left main coronary artery disease (CAD).
A 69-year-old female with a history of hypertension and paroxysmal atrial fibrillation presented with persistent heart failure refractory to diuretics. Ischaemic and infiltrative work-up were found to be negative with magnetic resonance imaging demonstrating trace pericardial fluid and thickening of the pericardium. Echocardiogram and right-heart catheterization demonstrated atypical haemodynamics suggestive of but not conclusive for CP, with coronary angiogram demonstrating severe left main CAD. Ultimately, the patient underwent coronary artery bypass grafting along with pericardiectomy and pericardial biopsy demonstrating constrictive physiology.
We suspect the inconclusive nature of the echocardiogram and cardiac catheterization was likely secondary to severe CAD impairing left ventricular relaxation and dampening ventricular interdependence. As such, clinicians should consider the possibility of coexistent severe CAD in patients with a clinical suspicion of CP, but inconclusive haemodynamics.
缩窄性心包炎（CP）是一种罕见疾病，其中心包逐渐纤维化且顺应性降低，导致心室充盈受损和明显的心衰。虽然CP与限制型心肌病在临床和血流动力学方面有许多相似之处，但区分这些疾病至关重要，因为CP通过心包切除术有可能治愈。在此，我们报告一例患有心力衰竭和严重左主干冠状动脉疾病（CAD）的患者，经证实存在心包缩窄且血流动力学不典型。
一名69岁女性，有高血压和阵发性心房颤动病史，因利尿剂难治性持续性心力衰竭就诊。磁共振成像显示微量心包积液和心包增厚，缺血性和浸润性检查结果均为阴性。超声心动图和右心导管检查显示血流动力学不典型，提示但不能确诊为CP，冠状动脉造影显示严重左主干CAD。最终，患者接受了冠状动脉旁路移植术以及心包切除术，心包活检显示存在缩窄性生理改变。
我们怀疑超声心动图和心脏导管检查结果不确定可能是由于严重CAD损害左心室舒张并减弱心室相互依赖所致。因此，临床医生在临床怀疑CP但血流动力学不确定的患者中应考虑并存严重CAD的可能性。
