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(Circulation. 2002;106:1022.)
© 2002 American Heart Association, Inc.

Images in Cardiovascular Medicine

Pericardial Adhesion Shown in Echocardiographic Subxiphoid View in a Patient With Postsurgical Pericardial Constriction

Shin-ichiro Hayashi, MD; Yuko Wada, MD; Hiroto Kitahara, MD; Mafumi Owa, MD

From the First Department of Internal Medicine (S.-i.H, M.O.), Second Department of Surgery (Y.W., H.K.), Shinshu University School of Medicine, Matsumoto, Japan.

Correspondence to Shin-ichiro Hayashi, MD, First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.

A 74-year-old woman who had undergone aortic valve replacement 3 years earlier was admitted to our hospital because of progressive right heart failure. Cardiac catheterization showed impaired diastolic filling (dip and plateau waveform) but lacked ventricular interdependence. Enlargement was marked in the right atrium and moderate in the left atrium (Figure 1A). Respiratory variation in transmitral Doppler E velocity was not significant (Figure 1B), but tricuspid E velocity during inspiration was increased by 31% over that measured during expiration (Figure 1C). Echocardiography in subxiphoid view revealed an unusual motion of the pericardium distinguished by a pulling on the liver (Figure 2). Subsequent thoracotomy revealed an area of thickened and adherent pericardium, chiefly around the anterior and diaphragmatic portions of the right ventricle (Figure 3). The physical signs of right heart failure abated after pericardiectomy, and the patient has continued to do well postoperatively.

View larger version (90K): [in this window] [in a new window]   Figure 1. Transthoracic echocardiogram in apical 4-chamber view (A) showing marked enlargement of the right atrium and moderate enlargement of the left atrium. Respiratory variation in transmitral Doppler E velocity is not significant (B), but tricuspid E velocity during inspiration is 31% higher than that during expiration (C). RA indicates right atrium; LA, left atrium; RV, right ventricle; LV, left ventricle; INSP, inspiration; and EXP, expiration.

View larger version (49K): [in this window] [in a new window]   Figure 2. M-mode echocardiogram in subxiphoid view showing an unusual motion of the pericardium, which pulls on the liver (arrows). Abbreviations as in Figure 1.

View larger version (126K): [in this window] [in a new window]   Figure 3. Histopathology of the resected pericardium showing a dense collagenous matrix consistent with fibrous pericarditis.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hayashi, S.-i. Articles by Owa, M. Search for Related Content PubMed PubMed Citation Articles by Hayashi, S.-i. Articles by Owa, M. Related Collections Echocardiography