ECHOCARDIOGRAPHY IN PATIENTS WITH CONSTRICTIVE PERICARDITIS BEFORE AND AFTER PERICARDIECTOMY - ARE THERE PREDICTORS OF SURGICAL OUTCOME

Fifteen patients with constrictive pericarditis were prospectively eva luated with echocardiography and Doppler recordings during respiratory monitoring. Eleven who agreed to surgery also underwent right heart c atheterization and a repeat echocardiography with Doppler 10 days afte r pericardiectomy. Preoperatively, there was a significant inspiratory decrease in the mitral E wave (P < 0.05) and increase in the tricuspi d E wave velocities (P < 0.05), which both normalized after pericardie ctomy. The mitral deceleration times increased from 110 +/- 40 to 149 +/- 46 msec (P < 0.05) postoperatively. The preoperative hepatic vein velocities showed an accentuated systolic flow pattern. The systolic t o diastolic ratio of the hepatic vein velocities was higher in patient s who improved with surgery (1.42 +/- 0.31 vs 0.65 +/- 0.13) (P < 0.05 ). Postoperatively the diastolic flow became more pronounced. There wa s a 100% expiratory diastolic flow reversal in eight patients preopera tively, which normalized after pericardiectomy. Clinically these patie nts improved significantly postoperatively. Left atrial size, ejection fraction, and mitral and tricuspid filling velocities during respirat ory monitoring could not predict surgical outcome. Pericardiectomy imp roved Doppler filling dynamics in all patients although this was not p arallel to clinical improvement.