Life-threatening constrictive pericarditis accompanied by synthetic cannabinoid use:A case report and literature review

Rationale:Synthetic cannabinoids are increasingly used as recreational drugs and have been associated with adverse cardiovascular effects.However,reports of synthetic cannabinoids accompanied by constrictive pericarditis are limited.Patient’s concern:A 28-year-old male with a history of synthetic cannabinoid(Bonzai)abuse presented with chest discomfort,dyspnea,and lower extremity edema.Investigations revealed reduced left ventricular ejection fraction,elevated inflammatory markers,low electrocardiogram voltages,and atrial fibrillation.Diagnosis:Chest spiral computerized tomography scan and chest X-ray demonstrated pericardial calcification.Cardiac magnetic resonance imaging and right heart catheterization were done to confirm the possibility of constrictive pericarditis.Based on the patient’s addiction history and exclusion of rheumatologic and infectious causes,it was supposed that constrictive pericarditis and cardiomyopathy may be accompanied by synthetic cannabinoid use.Interventions:The patient received standard medical therapy,including loop diuretics for cardiomyopathy and constrictive pericarditis.Catheter ablation was recommended for his rhythm control,and he was planned for close monitoring of clinical and echocardiographic response and evaluation of the need for surgical pericardiectomy in the future.Outcomes:After 6 months follow-up,echocardiographic exam revealed no significant improvement in ventricular function.However,due to the high surgical risk,the patient’s poor compliance,and the continuation of drug abuse,he was not a good candidate for surgery according to our heart team’s decision.Lessons:Synthetic cannabinoids can trigger constrictive pericarditis,and clinicians should consider them when evaluating patients with compatible symptoms and exposure history.Further research on the cardiovascular effects of synthetic cannabinoids is needed and public education on potential harms is warranted.

Chronic Effusive Pericarditis and Chronic Constrictive Pericarditis

Chronic Pericarditis is infl ammation that begins gradually,is long lasting and results in fl uid accumulation in the pericardial space or thickening of the pericardium.The etiology is unknown but may be cancer,TB or hypothyroidism.Arrhythmias are common and seen in almost half the patients.The commonest arrhythmia is atrial fi brillation.Symptoms and signs are related to increased right atrial pressure and physical fi ndings include elevated JVP and pericardial knock.Non surgical therapy consists mainly of no salt.Surgery cures about 85%of patients,however 5–15%of patients will die.Chronic effusive pericarditis occurs when there is persistent restriction of the visceral pericardium after pericardiocentesis.

Established and novel pathophysiological mechanisms of pericardial injury and constrictive pericarditis

This review article aims to:(1) discern from the literature the immune and inflammatory processes occurring in the pericardium following injury; and(2) to delve into the molecular mechanisms which may play a role in the progression to constrictive pericarditis. Pericarditis arises as a result of a wide spectrum of pathologies of both infectious and non-infectious aetiology, which lead to various degrees of fibrogenesis. Current understanding of the sequence of molecular events leading to pathological manifestations of constrictive pericarditis is poor. The identification of key mechanisms and pathways common to most fibrotic events in the pericardium can aid in the design and development of novel interventions for the prevention and management of constriction. We have identified through this review various cellular events and signalling cascades which are likely to contribute to the pathological fibrotic phenotype. An initial classical pattern of inflammation arises as a result of insult to the pericardium and can exacerbate into an exaggerated or prolonged inflammatory state. Whilst the implication of major drivers of inflammation and fibrosis such as tumour necrosis factor and transforming growth factor β were foreseeable, the identification of pericardial deregulation of other mediators(basic fibroblast growth factor, galectin-3 and the tetrapeptide Ac-SDKP) provides important avenues for further research.

Constrictive pericarditis as a cause of refractory ascites after liver transplantation:A case report

BACKGROUND Refractory ascites is a rare complication following orthotopic liver transplantation(OLT).The broad spectrum of differential diagnosis often leads to delay in diagnosis.Therapy depends on recognition and treatment of the underlying cause.Constrictive pericarditis is a condition characterized by clinical signs of right-sided heart failure.In the advanced stages of the disease,hepatic congestion leads to formation of ascites.In patients after OLT,cardiac etiology of ascites is easily overlooked and it requires a high degree of clinical suspicion.CASE SUMMARY We report a case of a 55-year-old man who presented with a refractory ascites three months after liver transplantation for alcoholic cirrhosis.Prior to transplantation the patient had a minimal amount of ascites.The transplant procedure and the early postoperative course were uneventful.Standard posttransplant work up failed to reveal any typical cause of refractory post-transplant ascites.The function of the graft was good.Apart from atrial fibrillation,cardiac status was normal.Eighteen months post transplantation the patient developed dyspnea and severe fatigue with peripheral edema.Ascites was still prominent.The presenting signs of right-sided heart failure were highly suggestive of cardiac etiology.Diagnostic paracentesis was suggestive of cardiac ascites,and further cardiac evaluation showed typical signs of constrictive pericarditis.Pericardiectomy was performed followed by complete resolution of ascites.On the follow-up the patient remained symptom-free with no signs of recurrent ascites and with normal function of the liver graft.CONCLUSION Refractory ascites following liver transplantation is a rare complication with many possible causes.Broad differential diagnosis needs to be considered.

“End-Stage” Constrictive Pericarditis—A Case Report

Aim: To report a case of “end-stage” constrictive pericarditis with clinical manifestations such as ascites mimicking as cirrhosis of liver. Introduction: In “End-stage” constrictive pericarditis, the etiology remains unknown in majority of cases and inflammation plays a central role in its development. It has been readily confused with cirrhosis of liver in which there may be ascites, but venous pressure is normal, the neck veins are not engorged and cardiac enlargement is frequent in other causes of heart failure. Case Report: A 67 years old male presented with sudden onset of tachycardia. Clinical examination revealed right-sided heart failure, “Egg-shell” calcification in Chest X-ray and echocardiographic features of pericardial constriction such as septal bounce and dynamic respiratory changes in mitral inflow velocity. The patient was advised medical measures. Conclusion: When clinical signs of right heart failure become unresponsive to increased doses of diuretics, constrictive pericarditis is more likely the underlying disease since severe, right-sided failure develops in very advanced, the “end-stage” of the disease.

Surgical Treatment of Chronic Constrictive Pericarditis in a Developing Country

Background: Chronic constrictive pericarditis is a rare but serious clinical entity with a poor prognosis in the absence of surgical treatment. The purpose of this study was to report on our experience of subtotal anterior pericardectomy and analyze our surgical results. Results: We included 74 patients operated on for chronic constrictive pericarditis in our institution during the period from January 1985 to December 2020. There were 29 female and 45 male patients, with an average age of 28 years (range: 8 - 64 years). 36.5% of patients were in NYHA class III or IV. Physical signs were dominated by peripheral signs of right heart failure in 93.2% of cases. The surgical procedure was a subtotal anterior pericardectomy from the left to the right phrenic nerve, freeing the heart chambers and the large vessels. The surgical results were marked by a functional improvement in 82.4% of the cases. The postoperative complications were marked by a low cardiac output in 8.1% of the cases, a atrial fibrillation in 4.1% of the cases, a haemorrhage in 1.4% of the cases, a haemothorax in 2.7% of the cases. Perioperative mortality was 5.4% patients. The causes of death were low cardiac output in 50% of cases, hemorrhage in 25% of cases, and hepatocellular insufficiency in 25% of cases. We observed a mortality of 2.9% after an average follow-up of 5.17 years ± 4.76 years. All other survivors were asymptomatic and no re-intervention for recurrence was performed. Conclusions: Subtotal anterior pericardectomy was the technique we used for the treatment of chronic constrictive pericarditis. It allowed having satisfactory surgical results with a functional improvement and an acceptable morbidity.

Effect of Right Heart Systolic Function on Outcomes in Patients with Constrictive Pericarditis Undergoing Pericardiectomy

Background： To determine the influence of right ventricular function in patients with constrictive pericarditis （CP） undergoing surgery and to compare the outcomes of patients who received surgery with those managed medically. Methods： Patients with the diagnosis of CP and healthy volunteers were recruited from January 2006 to November 2011. Patients with CP chose to either receive pericardiectomy or medical management. Echocardiographic measurements were performed to evaluate heart function, and survival was recorded. Results： A total of 58 patients with CP （36 received pericardiectomy, 22 managed medically）, and 43 healthy volunteers were included. CP patients who received surgery had a higher survival rate than those managed medically （P = 0.003）, and higher st, rvival was also seen in the subgroup of CP patients with severely impaired right systolic function. Albumin level, left ventricular end-diastolic dimension, and tricuspid regurgitation velocity were associated with survival in CP patients who received surgery. Conclusions： Preoperative right heart function does not affect surgical outcomes. Patients with severely impaired preoperative right systolic function obtain a greater survival advantage with surgery than with medical treatment.

Chylous Ascites and Chylothorax Caused by Constrictive Pericarditis

Chylous ascites and chylopleura due to constrictive pericarditis are rare and characterized by white milky ascites and pleural fluid. presence of chylomicrons Diagnosis is established by the However, the treatment of this situation is very difficult. We report a case ofchylous ascites and chylotborax, in which hydrops was attributable to constrictive pericarditis. In the present case, pericardiectomy combined with thoracic duct ligation and pleurodesis cured chylous ascites and cbylothorax caused by constrictive pericarditis, which has never been previously described.

A rare chronic constrictive pericarditis with localized adherent visceral pericardium and normal parietal pericardium： a case report

Classic constrictive pericarditis （CP） is characterized by fibrous scarring and adhesion of both the visceral pericardium and the parietal pericardium, which leads to restricted cardiac filling. However, diagnosing CP with normal thickness pericardium and without calcification is still a challenge. The predominant cause in the developed world is idiopathic or viral pericarditis followed by post-cardiac surgery and post-radiation. Tuberculosis still remains a common cause of CP in developing countries. In this report, we describe a rare case of idiopathic localized constrictive visceral pericardium with normal thickness of the parietal pericardium in a middle-aged man. The patient presented with unexplained right heart failure and eehocardiography showed moderate bi-atrial enlargement which should be identified with the restrictive cardiomyopathy. After 10 months of conservative treatment, the progression of right heart failure was remaining. A pericardiectomy was performed and the patient recovered. This case serves as a reminder to consider CP in patients with unexplained right heart failure, so that timely investigation and treatment can be initiated.

缩窄性心包炎的MRI诊断

目的 评价MRI检查缩窄性心包炎的诊断价值。材料与方法 回顾性分析临床证实的 2 6例缩窄性心包炎MRI表现。结果 MRI发现 2 4例心包有增厚 ,2例正常。增厚的心包T1WI上 2 0例呈中等信号 ,4例为低信号。右心室腔呈管状狭窄者 6例 ,右心室前壁僵直、右心室腔呈三角形者 13例 ,5例右心室略大。 11例电影MRI均显示右心室舒张受限。右房除 2例外均有不同程度的增大 ,左房有 4例增大 ,19例发现有上、下腔静脉扩张。结论 MRI能直接显示极大多数病例增厚的心包 ,并确定其部位和范围 ,对诊断缩窄性心包炎和与限制性心肌病鉴别有重要价值 ,可在某些诊断有争议的病例中选择性应用。

112例结核性缩窄性心包炎外科治疗的临床分析

目的总结我院结核性缩窄性心包炎患者行外科手术治疗的经验,分析手术相关危险因素以及患者的临床预后。方法2005年1月至2018年12月,共计112例结核性缩窄性心包炎患者在我院行手术治疗。回顾性分析患者临床资料,对术后随访数据进行统计分析。结果患者院内死亡率为3.6%。患者术前症状持续时间<1年的62例,占55.4%,早期死亡率明显低于症状>1年的患者(P<0.05)。术前左室射血分数(LVEF)≥50%的患者早期死亡率明显低于LVEF<50%的患者(P<0.01)。再次心包剥脱手术患者的早期死亡率明显高于首次手术患者(P<0.01)。术后中位随访时间51月,患者术后5年生存率为91.9%,10年生存率为84.8%。结论外科手术治疗结核性缩窄性心包炎是安全有效的,手术能明显改善患者的心脏功能。

缩窄性心包炎患者行心包剥脱术后的心功能维护

目的促进缩窄性心包炎患者行心包剥脱术后心功能恢复。方法针对33例行心包剥脱术的缩窄性心包炎患者术后出现的心功能不全甚至急性心力衰竭,以及困难脱机等临床表现,实施精细化管理出入量,合理使用正性肌力药物及机械装置,保持气道通畅,加强急性心功能不全的救护等措施。结果术后发生右心功能不全12例,低心排综合征10例,再次气管插管4例。本组患者呼吸机使用时间4~943 h(中位数45 h),ICU停留时间1~42 d(中位数4 d)。31例康复出院,2例因再次心脏手术后并发严重并发症自动转院。结论缩窄性心包炎患者心包剥脱术后易并发心功能不全,术后全方位综合护理有利于患者心功能恢复。

缩窄性心包炎诊断技术的研究进展

缩窄性心包炎(CP)是由于各种原因导致心包的增厚、粘连、钙化和纤维化等,致使心脏舒张功能受限,早期出现右心衰竭的症状和体征,若不经及时治疗,可导致全心衰竭等不良心血管事件的发生。由于症状非特异性,起病隐匿,CP常被误诊为其他心血管或非心血管疾病,如冠心病、限制型心肌病和淤血性肝病等。现阶段对于CP的诊断集中在无创影像技术上,超声心动图是首要的检查方法,CT和磁共振成像可显示心包解剖结构及评估心包炎症等;当无创技术不能明确诊断时,可监测血流动力学以及监测因CP所致静脉系统压力升高测得的外周静脉压以辅助诊断;而以上均无法明确时,可通过手术行病理活检明确诊断。CP的诊断具有挑战性,容易被漏诊和误诊,为此现综述该病的诊断技术现状及进展。

组织多普勒联合心房容积追踪技术对缩窄性心包炎心房容积的研究机制

目的分析组织多普勒联合心房容积追踪技术在缩窄性心包炎心房容积评估中的价值。方法选取2021年1月至2022年5月期间我院收治的50例缩窄性心包炎患者为观察组,收集同期在我院接受健康体检50例健康者为对照组,所有对象均通过心房容积追踪技术对患者心房容积、功能进行评估,通过组织多普勒对心房电-机械耦联时间、心房间和心房内传导延迟时间进行测量,分析评估结果。结果观察组LAVImax、RAVImax、LAVIpre、RAVIpre、LAVImin、RAVImin明显比对照组高(P<0.05);LAEEt、RAEEt、LAEFp、RAEFp、LAEFa、RAEFa均比对照组低(P<0.05);观察组P-ALA、P-AIAS、P-ARA和TLA、TRA、TL-R均比对照组高(P<0.05)。结论组织多普勒联合心房容积追踪技术可以准确对缩窄性心包炎心房容积和心功能进行评估,为患者临床指标提供更多参考依据。

92例缩窄性心包炎误诊分析

目的:探讨缩窄性心包炎的误诊原因。方法:回顾性总结我院2000-01至2008-01年连续诊断的150例缩窄性心包炎患者的门诊与住院资料。结果:在150例患者中,92例在病程中曾发生误诊,误诊率61.3%。92例心包缩窄的病因分别为:结核81.5%(75/92),其他疾病15.2%(14/92),不明原因3.3%(3/92)。误诊为其他心血管疾病及其他各种疾病51例,诊断为结核性心包炎、胸膜炎等进行抗结核治疗但未识别出心包缩窄的22例,长期诊断不明17例,2例非结核误诊为结核。隐匿起病者误诊率高,无心包积液病史的患者误诊率高,不典型结核误诊率高,合并全身多处结核的易漏诊心包缩窄。结论:缩窄性心包炎误诊率仍较高,临床医生提高对缩窄性心包炎的警惕以及心脏超声医生提高对缩窄性心包炎的认识可减少误诊,上腔系统静脉压升高的表现是缩窄性心包炎的重要体征,临床医生应充分重视体格检查。

缩窄性心包炎手术治疗79例临床分析

目的探讨提高缩窄性心包炎的手术疗效方法。方法回顾性分析近10年来79例缩窄性心包炎患者的治疗。男性51例,女性28例。年龄7～71(29.21±12.98)岁。术前心功能Ⅱ级6例,Ⅲ级51例,Ⅳ级22例。前胸正中切口64例,左前外侧切口15例。均在全麻下行部分心包剥脱术。结果围术期死亡4例,其中术后低心输排量综合征2例,术中右室流出道破裂出血修补失败1例,术后全身衰竭1例。3例术后症状改善不明显。结论手术治疗缩窄性心包炎是最有效的方法,一旦确诊应尽早手术治疗。

组织多普勒速度成像定量测量瓣环运动速度评价缩窄性心包炎患者术后心功能改变

目的应用组织多普勒技术定量评价缩窄性心包炎(CP)患者手术治疗后心脏收缩、舒张功能改变。方法选取已确诊为CP且择期接受CP心包剥脱术的患者22例,于手术前及术后1个月分别行超声检查,存储心尖四腔心、心尖两腔心及心尖部左心室长轴切面组织多普勒二维图像,以定量组织多普勒技术分析并记录二尖瓣环各部位及三尖瓣环侧壁收缩期及舒张期峰值运动速度(S'、E'),分别计算各个节段S'、E'及三尖瓣环的平均速度作为二尖瓣环的总体运动速度。结果 CP患者术后1个月左心室变大(P<0.001),左心房(P=0.011)及右心房(P=0.004)呈不同程度缩小,左心室射血分数增高(P=0.021);三尖瓣环、二尖瓣环左心室侧壁及室间隔S'、E'均有不同程度减低(P均<0.05),三尖瓣环、二尖瓣环S'、E'峰亦有不同程度减低(P均<0.01)。结论 CP患者术后左心室射血分数增加,心脏各腔室发生趋于正常的重构;术后短期内切除心包瓣环部位S'及E'较术前减低,表明左心室壁纵向运动速度减低。

外科治疗缩窄性心包炎128例

目的总结分析128例缩窄性心包炎的外科治疗经验。方法回顾分析128例经外科手术治疗的慢性缩窄性心包炎患者的临床资料。结果本组术后早期死亡2例,死亡率1.57%,死亡原因:均为严重低心排综合征。其它并发症有:低心排综合征17例(13.2%),心律失常9例(7.02%),急性肾功能不全5例(3.9%),呼吸功能不全4例(3.1%),伤口感染3例(2.3%),术后胸内出血2例(1.6%),脑梗塞1例(0.78%)。早期1例因心包切除不彻底而复发。结论缩窄性心包炎应尽早确诊,积极手术,术中心包切除范围因病情而定,力求彻底松解病变心包,术后积极预防各种并发症的发生。

慢性缩窄性心包炎的诊断及手术治疗

目的总结分析慢性缩窄性心包炎的诊断和治疗经验。方法回顾性分析1993年1月-2006年10月96例慢性缩窄性心包炎的临床资料，男62例，女34例，年龄5～74岁，平均34岁，术前心功能Ⅱ级8例，Ⅲ级70例，Ⅳ级18例。胸骨正中切口88例，左前外侧切8例，均在全麻下行部分心包剥脱术。结果围术期死亡2例，其中术后低心排血综合征1例，术中右心房破裂出血修补失败1例，96例中有92例获得随访，心功能恢复到Ⅰ级者86例，恢复到Ⅱ级者6例。结论心包剥脱术仍是治疗此病惟一有效的方法，早期诊断、及时手术、充分合理的心包剥脱范围，正确的围术期处理是手术成功和提高远期疗效的关键。

缩窄性心包炎临床诊疗

目的总结缩窄性心包炎的诊断和治疗经验。方法回顾性分析1995年1月—2008年3月我院52例接受心包剥离术患者的临床资料,对缩窄性心包炎的病因、诊断和治疗方法进行分析总结。结果心包慢性炎症改变34例,结核增殖性肉芽组织形成或干酪样变18例。胸部X线诊断为肺结核15例;23例行胸部CT检查,其中诊断为肺内结核8例,双侧胸腔积液15例,心包积液3例,心包膜弥漫或局限性增厚23例(其中心包钙化4例),纵隔淋巴结肿大6例;心脏彩色多普勒检查,42例可见不同程度的心包增厚、粘连、心搏减弱,6例有心包积液;心电图提示房颤11例,T波或ST段改变22例,窦性心动过速37例,QRS波低电压42例。常规颈内静脉置管测中心静脉压,全部患者采用气管内插管全身麻醉、胸部正中切口行心包剥离术。1例因多脏器功能衰竭死亡,病死率为1.9%。术后并发低心排血量综合征5例,心律失常4例及肺部感染3例。出院时心功能Ⅰ～Ⅱ级45例,Ⅲ级6例。结论早期正确诊断,及时手术治疗和正确的围术期处理是缩窄性心包炎治疗成功的关键。