LEFT ATRIAL DILATATION IN CONSTRICTIVE PERICARDITIS - A PRE AND POSTOPERATIVE ECHOCARDIOGRAPHIC STUDY

Thirty-three surgically proven cases of constrictive pericarditis were studied pre-operatively by echocardiography for left atrial dilatatio n and 18 of them underwent post-operative study at a mean follow-up pe riod of 229 +/- 105 days. The degree of left atrial dilatation in thes e patients was compared with patients of restrictive cardiomyopathy (n = 8) and sex matched controls of similar age (n = 33). Significant le ft atrial dilatation was present in patients of constrictive pericardi tis compared to controls and it was of a similar or greater degree com pared to patients of restrictive cardiomyopathy (the left atrium to ao rta ratio was 1.7 +/- 0.31, 1.53 +/- 0.18 and 1.07 +/- 0.1, in constri ctive pericarditis, restrictive cardiomyopathy and controls, respectiv ely, P = NS for constrictive pericarditis vs. restrictive cardiomyopat hy and P < 0.001 for constrictive pericarditis vs, controls). There wa s no correlation of degree of left atrial dilatation with clinical and hemodynamic variables, Postoperatively, there was regression of left atrial size in patients with normal hemodynamics (n = 12, pre- vs. pos t-operative left atrium to aorta ratio 1.65 +/- 0.23 vs. 1.32 +/- 0.14 , P less than or equal to 0.001) and persisting or increasing left atr ial dilatation in patients with persisting hemodynamic abnormality (n = 6, left atrium to aorta ratio 1.66 +/- 0.23 vs. 1.82 +/- 0.15, P = N S). We conclude that significant left atrial dilatation is a consisten t echocardiographic feature of constrictive pericarditis. Hemodynamic normalization following successful pericardiectomy is associated with regression of atrial size.