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(Circulation. 1999;99:2476-2479.)
© 1999 American Heart Association, Inc.

Correspondence

Diagnosis of Constrictive Pericarditis

Robert B. McCully, MD; Stuart T. Higano, MD; Jae K. Oh, MD

Division of Cardiovascular Diseases, Mayo Medical Center, Rochester, Minn

To The Editor:

The interesting case featured in "Images in Cardiovascular Medicine" in the March 3, 1998, issue of Circulation¹ illustrates how elusive the diagnosis of constrictive pericarditis can be and demonstrates how important it is to perform a comprehensive 2-dimensional/Doppler echocardiographic examination on all patients referred to the echocardiography laboratory. In patients with symptoms and signs of congestive heart failure, it does not suffice to simply report on the systolic function of the left and right ventricles. Comprehensive evaluation should include assessment of diastolic function. Likewise, a comprehensive invasive evaluation, if needed, should not be limited to the nonspecific findings of a dip-and-plateau waveform and equalization of elevated ventricular diastolic pressures but should include an assessment of ventricular interdependence.²

Two-dimensional echocardiographic features suggestive of constrictive pericarditis, namely, abnormal motion of the interventricular septum and a dilated inferior vena cava, should prompt serious consideration of this diagnosis. Using pulsed-wave Doppler to assess diastolic filling, the echocardiographer can provide confirmatory evidence of constrictive pericarditis by demonstrating respiration-related changes in the mitral and tricuspid inflow velocities and in pulmonary vein and hepatic vein flow.^{2 3}

The traditional criteria used for the invasive diagnosis of constrictive pericarditis have been shown to be nonspecific.⁴ Simultaneous right and left heart catheterization should include an assessment of the dynamic changes in intracardiac pressures that occur with respiration. Right and left ventricular systolic pressure changes are discordant in constrictive pericarditis because there is increased ventricular interdependence; these discordant changes are highly predictive of constrictive pericarditis.⁴

The decrease in . . . [Full Text of this Article]

Ezra A. Amsterdam, MD

Professor of Medicine Director, Coronary Care Unit

Seven D. Correa, MD

Assistant Professor of Medicine, Cardiovascular Medicine, University of California, Davis, Sacramento, Calif