김성순

심원흠

장병철

정남식

조승연

최병욱

하종원

Circulation

Yonsei University Medical Library Open Access Repository

Constrictive Epicarditis as an Unusual Cause ofConstrictive PhysiologyTypical Presentation With Unusual PathologyJong-Won Ha, MD, PhD; Byung-Chul Chang, MD, PhD; Byoung-Wook Choi, MD;Namsik Chung, MD, PhD; Won-Heum Shim, MD, PhD;Seung-Yun Cho, MD, PhD; Sung-Soon Kim, MD, PhDThis case represents typical clinical and hemodynamic fea-tures of constrictive pericarditis, but the underlying pathol-ogy was epicardial rather than pericardial scarring. The recog-nition of constrictive epicarditis as distinct from pericarditis isimportant because the surgical approach is different.An 83-year-old woman was evaluated for progressivelyworsening exertional dyspnea and generalized edema. Onphysical examination, the jugular vein was distended and theliver was enlarged. An ECG showed atrial fibrillation. Achest lateral film showed a pericardial calcification (Figure1). Computed tomography of the heart showed a calcificationring encircling the ventricle (Figure 2). Calcific constrictivepericarditis was diagnosed, and pericardiectomy was planned. Atsurgery, the parietal pericardium was mildly fibrothickened;however, dense, calcified, ossified epicardial thickening firmlyattached especially on the left and right atrioventricular groove,which constituted the basis for marked impaired filling of the leftventricle (Figures 3 and 4; Data Supplement). The lesion wasremoved after careful dissection via scalpel. The woman’scentral venous pressure dropped from 17 mm Hg to 11 mm Hgafter the operation. The patient subsequently recovered and wasuneventfully discharged days later.From the Divisions of Cardiology, Cardiovascular Surgery and Diagnostic Radiology, Yonsei University College of Medicine, Seoul, South Korea.The online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/111/21/e365/DC1.Correspondence to Jong-Won Ha, Cardiology Division, Yonsei University College of Medicine, Yonsei Cardiovascular Center, CPO Box 8044, Seoul,South Korea 120-752. E-mail jwha@yumc.yonsei.ac.kr(Circulation. 2005;111:e365-e366.)© 2005 American Heart Association, Inc.Circulation is available at http://www.circulationaha.org DOI: 10.1161/CIRCULATIONAHA.104.472209Figure 1. Pericardial calcification.Figure 2. Calcification ring encircling the ventricle.e365Images in Cardiovascular Medicine at CONS KESLI on May 8, 2015http://circ.ahajournals.org/Downloaded from Figure 4. Removed calcifications.Figure 3. Surgical findings.e366 Circulation May 31, 2005 at CONS KESLI on May 8, 2015http://circ.ahajournals.org/Downloaded from Seung-Yun Cho and Sung-Soon KimJong-Won Ha, Byung-Chul Chang, Byoung-Wook Choi, Namsik Chung, Won-Heum Shim,Presentation With Unusual PathologyConstrictive Epicarditis as an Unusual Cause of Constrictive Physiology: TypicalPrint ISSN: 0009-7322. Online ISSN: 1524-4539 Copyright © 2005 American Heart Association, Inc. All rights reserved.is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231Circulation doi: 10.1161/CIRCULATIONAHA.104.4722092005;111:e365-e366Circulation.  http://circ.ahajournals.org/content/111/21/e365World Wide Web at: The online version of this article, along with updated information and services, is located on the http://circ.ahajournals.org/content/suppl/2005/06/14/111.21.e365.DC1.htmlData Supplement (unedited) at:   http://circ.ahajournals.org//subscriptions/is online at: Circulation  Information about subscribing to Subscriptions:   http://www.lww.com/reprints Information about reprints can be found online at: Reprints:  document. Permissions and Rights Question and Answer this process is available in theclick Request Permissions in the middle column of the Web page under Services. Further information aboutOffice. Once the online version of the published article for which permission is being requested is located,  can be obtained via RightsLink, a service of the Copyright Clearance Center, not the EditorialCirculationin Requests for permissions to reproduce figures, tables, or portions of articles originally publishedPermissions: at CONS KESLI on May 8, 2015http://circ.ahajournals.org/Downloaded from 

Constrictive epicarditis as an unusual cause of constrictive physiology: typical presentation with unusual pathology

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Constrictive epicarditis as an unusual cause of constrictive physiology: typical presentation with unusual pathology

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