Constrictive chronic pericarditis in children

Constrictive pericarditis is a uncommom disease in children. We have now en countered pericardial thickening as the cause of severe constrictive physio logy in two patients, one also having haemodynamic features of restrictive cardiomyopathy. Both patients, who had refractory ascites and evidence of i ncreased systemic venous pressure, underwent Doppler echocardiography, card iac catheterisation, and magnetic resonance imaging. Resonance imaging fail ed to show any thickning of the pericardium, but cardiac catheterisation re vealed diastolic equalisation of pressures in all four chambers, with only mild elevation of pulmonary pressure in the first patient, but nearly equal isation of diastolic pressure, and a very high pulmonary arterial pressure with a difference of 7 mm Hg between the end diastolic pressures in the two ventricles in the second patient. Doppler revealed a restrictive pattern o f mitral inflow, with high E and small A velocities and a short deceleratio n time. The clinical background did not suggest pericardial disease in eith er of the patients. We conclude that a careful search is needed to uncover constrictive pericarditis when there is no previous disease which may sugge st late pericardial constriction. The haemodynamic features of restrictive cardiomyopathy can co-exist with pericardial restriction, and differentiati on between the two entities is critical in view of the diverse management a nd prognosis of the two conditions.