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Fading Out Dip-and-Plateau Pattern of Right Ventricular Pressure in Constrictive Pericarditis

2010; Lippincott Williams & Wilkins; Volume: 122; Issue: 4 Linguagem: Inglês

10.1161/circulationaha.109.917526

1524-4539

Hiroshi Imagawa, Kei‐ichi Ishikawa,

Cardiac tumors and thrombi

HomeCirculationVol. 122, No. 4Fading Out Dip-and-Plateau Pattern of Right Ventricular Pressure in Constrictive Pericarditis Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBFading Out Dip-and-Plateau Pattern of Right Ventricular Pressure in Constrictive Pericarditis Hiroshi Imagawa, MD and Keiichi Ishikawa, MD Hiroshi ImagawaHiroshi Imagawa From the Department of Regeneration of Community Medicine (H.I.), Ehime University School of Medicine, To-on, Ehime, Japan, and Ishikawa Hospital (K.I.), Shikokuchuo, Ehime, Japan. and Keiichi IshikawaKeiichi Ishikawa From the Department of Regeneration of Community Medicine (H.I.), Ehime University School of Medicine, To-on, Ehime, Japan, and Ishikawa Hospital (K.I.), Shikokuchuo, Ehime, Japan. Originally published27 Jul 2010https://doi.org/10.1161/CIRCULATIONAHA.109.917526Circulation. 2010;122:404–405A 64-year-old woman presented with general fatigue and abdominal distension of several months' duration. She had no history of cardiac surgery, mediastinal irradiation, or infectious diseases. Computed tomography revealed constrictive pericarditis with massive ascites and pleural effusion. Surgical therapy was indicated. Doppler sonography of the hepatic vein demonstrated a typical W-shaped pattern with reverse flow during expiration (Figure 1). Under general anesthesia, the chest was opened via a median sternotomy while right ventricular (RV) pressure was monitored with a pulmonary artery balloon catheter (780HF75, Swan-Ganz oximetry Paceport TD catheter, Edwards Lifesciences, Irvine, Calif), which was equipped with an RV lumen. RV pressure showed a typical dip-and-plateau pattern (square root sign; Figure 2A). The calcified pericardium adhered tightly to the epicardium without effusion. Download figureDownload PowerPointFigure 1. W-shaped pulsatility of the hepatic vein, showing reverse flow during expiration.Download figureDownload PowerPointFigure 2. A, RV pressure showed an early rapid fall in the diastolic phase, followed by a rapid rise to an elevated diastolic pattern. The dip-and-plateau pattern remaining during the pericardiectomy on the anterior and inferior cardiac surface (B and C). Square root sign of the RVP faded out during decortication of the posterolateral pericardium (D and E). Disappeared dip-and-plateau pattern (F). AoP indicates aortic pressure.We dissected the pericardium overlying the right ventricle, right atrium, venae cavae, and anterior wall of the left ventricle using a surgical knife, scissors, and an ultrasonic scalpel (Harmonic Scalpel, Ethicon Endo-Surgery Inc, Cincinnati, Ohio; hemodynamics shown in Figure 2B). Pericardiectomy was performed on the inferior cardiac surface, which was fully exposed by elevating and rotating the left ventricle with a cardiac positioner (Tentacles, Sumitomo Bakelite Co Ltd, Tokyo, Japan). However, RV pressure still showed a dip-and-plateau pattern (Figure 2C). To expose a deep surgical field of vision and gain sufficient operative space, we adopted a partial cardiopulmonary bypass. The posterolateral pericardium was decorticated, with the exception of a band near the left phrenic nerve. The dip-and-plateau pattern of the RV pressure faded out during the procedure (Figures 2D and 2E). The patient was weaned off of cardiopulmonary bypass, and the operation was completed with no complications or problems. After the median sternotomy was closed, pressure measurements demonstrated the dip-and-plateau pattern of the RV pressure had disappeared (Figure 2F) without administration of cardiac inotropes. The patient recovered uneventfully. On follow-up, the patient was well, with no ascites or pleural effusion (Figure 3). Download figureDownload PowerPointFigure 3. Preoperative chest computed tomography identified the thickened and calcified pericardium (A), which disappeared in computed tomographic images after pericardiectomy (B). Massive ascites seen in preoperative computed tomographic images (C) showed improvement on postoperative evaluation (D).Hansen and colleagues1 reported the typical RV pressure pattern in patients with constrictive pericarditis and their postoperative improvements in 1951; however, there have been few studies that have well illustrated when RV hemodynamics improve after pericardiectomy. In the present case, the dip-and-plateau pattern faded out during decortication of the posterolateral pericardium.DisclosuresNone.FootnotesCorrespondence to Hiroshi Imagawa, MD, Department of Regeneration of Community Medicine, Ehime University School of Medicine, To-on, Ehime, 791-0295 Japan. E-mail [email protected]Reference1 Hansen AT, Eskildsen P, Gotzsche H. Pressure curves from the right auricle and the right ventricle in chronic constrictive pericarditis. Circulation. 1951; 3: 881–888.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Saito T, Fukushima S, Yamasaki T, Kawamoto N, Tadokoro N, Kakuta T, Ikuta A, Minami K, Ohta Y and Fujita T (2022) Pericardiectomy for constrictive pericarditis at a single Japanese center: 20 years of experience, General Thoracic and Cardiovascular Surgery, 10.1007/s11748-021-01718-x, 70:5, (430-438), Online publication date: 1-May-2022. Nozohoor S, Johansson M, Koul B and Cunha-Goncalves D (2018) Radical pericardiectomy for chronic constrictive pericarditis, Journal of Cardiac Surgery, 10.1111/jocs.13715, 33:6, (301-307), Online publication date: 1-Jun-2018. Syed F, Schaff H and Oh J (2014) Constrictive pericarditis—a curable diastolic heart failure, Nature Reviews Cardiology, 10.1038/nrcardio.2014.100, 11:9, (530-544), Online publication date: 1-Sep-2014. July 27, 2010Vol 122, Issue 4 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.109.917526PMID: 20660816 Originally publishedJuly 27, 2010 PDF download Advertisement SubjectsCardiovascular SurgeryPericardial Disease