CHRONIC CONSTRICTIVE PERICARDITIS - 3 CAS ES PRESENTING WITH REFRACTORY CARDIAC-FAILURE

Chronic constrictive pericarditis is a difficult diagnosis and may pre sent atypically. The authors report three clinical cases and review th e diagnostic strategy of constrictive pericarditis. In these three pat ients, the diagnosis was finally made after one or more years of sympt omatic disease and after several diagnostic work ups and ineffective t reatments. In cardiac failure, pericardial calcification is often not observed on chest X-ray and Doppler echocardiography is usually the di agnostic investigation. Adiastole presents with dilatation of the vena cava and atria, contrasting with normal ventricles without major valv ular disease. Doppler echocardiography enables distinction of constric tive pericarditis from restrictive cardiomyopathy : normal myocardium, thickened pericardium, specific septal motion, inspiratory increase i n right ventricular dimensions, premature opening of the pulmonary val ve, important variations in ventricular filing with respiration, expir atory diastolic reflux in the hepatic veins. Catheterisation confirms adiastole and may suggest a pericardial aetiology in characteristic ca ses, associated with only mild increases in pulmonary artery pressure. If need be, the pericardial thickening >4 mm may be observed with mag netic nuclear resonance imaging and, when a doubt remains with respect to the diagnosis of cardiomyopathy, the absence of fibrosis on endomy ocardial biopsy provides the diagnosis and indication for curative sur gery : pericardectomy.