Constrictive pericarditis in 26 patients with histologically normal pericardial thickness

• Published in: Circulation (New York, N.Y.) Vol. 108; no. 15; pp. 1852 - 1857
• Main Authors: TALREJA, Deepak R, EDWARDS, William D, DANIELSON, Gordon K, SCHAFF, Hartzell V, TAJIK, A. Jamil, TAZELAAR, Henry D, BREEN, Jerome F, OH, Jae K
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 14.10.2003; American Heart Association, Inc
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiology. Vascular system; Comorbidity; Diagnostic Imaging; Diseases of the pericardium; Female; Follow-Up Studies; Heart; Hemodynamics; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - pathology; Pericardiectomy; Pericarditis, Constrictive - pathology; Pericarditis, Constrictive - surgery; Pericardium - pathology; Pericardium - radiation effects; Postoperative Complications - pathology; Radiation Injuries - pathology; Retrospective Studies; Single-Blind Method; Human; Pericardial constriction; pathology; pericarditis; Heart disease; Pericardial disease; Clinical form; Cardiovascular disease; Wall thickness; Pericardium
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.0000087606.18453.FD

Traditionally, increased pericardial thickness has been considered an essential diagnostic feature of constrictive pericarditis. Although constriction with a normal-thickness pericardium has been demonstrated clinically by noninvasive imaging, the details of clinicopathological correlates have not been described. A total of 143 patients with proven constriction underwent pericardiectomy at Mayo Clinic between 1993 and 1999. Their baseline characteristics, operative data, and pathological specimens were reviewed retrospectively. The pericardium was of normal thickness (< or =2 mm) in 26 patients (18%; group 1) and was thickened (>2 mm) in 117 (82%; group 2). The most common causes of constriction in group 1 included previous cardiac surgery, chest irradiation, previous infarction, and idiopathic disease. There was little difference in symptoms and findings on physical examination between the 2 groups. Microscopically, no patient had an entirely normal pericardium. Histopathological abnormalities in group 1 were mild and focal, including fibrosis, inflammation, calcification, fibrin deposition, and focal noncaseating granulomas. Pericardiectomy was equally effective in relieving symptoms regardless of the presence or absence of increased thickness. Pericardial thickness was not increased in 18% of patients with surgically proven constrictive pericarditis, although the histopathological appearance was focally abnormal in all cases. When clinical, echocardiographic, or invasive hemodynamic features indicate constriction in patients with heart failure, pericardiectomy should not be denied on the basis of normal thickness as demonstrated by noninvasive imaging.