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      Rare Concurrence of Apical Hypertrophic Cardiomyopathy and Effusive Constrictive Pericarditis

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          Abstract

          A 78-year-old man with a history of pulmonary tuberculosis was referred for preoperative evaluation of cardiac function. Echocardiography and cardiac cine magnetic resonance imaging (MRI) indicated apical hypertrophic cardiomyopathy (HCM), a thickened visceral pericardium, and a large pericardial effusion. Cardiac late gadolinium-enhanced MRI revealed pericardial inflammation or fibrosis. Apical HCM with concurrent effusive constrictive pericarditis was diagnosed. Further studies are required to elucidate the pathophysiology of this condition.

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          Effusive-constrictive pericarditis.

          Juan R Angel, Jaume Sauleda, Gaietà Permanyer-Miralda … (2004)
          Effusive-constrictive pericarditis is an uncommon pericardial syndrome characterized by concomitant tamponade, caused by tense pericardial effusion, and constriction, caused by the visceral pericardium. We conducted a prospective study of its clinical evolution and management. From 1986 through 2001, all patients with effusive-constrictive pericarditis were prospectively evaluated. Combined pericardiocentesis and cardiac catheterization were performed in all patients, and pericardiectomy was performed in those with persistent constriction. Follow-up ranged from 1 month to 15 years (median, 7 years). A total of 1184 patients with pericarditis were evaluated, 218 of whom had tamponade. Of these 218, 190 underwent combined pericardiocentesis and catheterization. Fifteen of these patients had effusive-constrictive pericarditis and were included in the study. All patients presented with clinical tamponade; however, concomitant constriction was recognized in only seven patients. At catheterization, all patients had elevated intrapericardial pressure (median, 12 mm Hg; interquartile range, 7 to 18) and elevated right atrial and end-diastolic right and left ventricular pressures. After pericardiocentesis, the intrapericardial pressure decreased (median value, -5 mm Hg; interquartile range, -5 to 0), whereas right atrial and end-diastolic right and left ventricular pressures, although slightly reduced, remained elevated, with a dip-plateau morphology. The causes were diverse, and death was mainly related to the underlying disease. Pericardiectomy was required in seven patients, all of whom had involvement of the visceral pericardium. Three patients had spontaneous resolution. Effusive-constrictive pericarditis is an uncommon pericardial syndrome that may be missed in some patients who present with tamponade. Although evolution to persistent constriction is frequent, idiopathic cases may resolve spontaneously. In our opinion, extensive epicardiectomy is the procedure of choice in patients requiring surgery. Copyright 2004 Massachusetts Medical Society
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            Comparison of prevalence of apical hypertrophic cardiomyopathy in Japan and the United States.

            Takashi Furuno, Barry J Maron, Kenneth S. Casey … (2003)
            The morphologic apical form of hypertrophic cardiomyopathy (HC), in which left ventricular (LV) wall thickening is confined to the most distal region at the apex, has been regarded as a phenotypic expression of nonobstructive HC largely unique to Japanese patients. To investigate this question further, we directly compared unselected and regional hospital-based cohorts of adult patients with HC ( > or =18 years of age) from Japan (Kochi; n=100) and from the United States (US) (Minneapolis; n=361). Japanese and American patients with HC had similar clinical features and did not differ significantly with regard to the severity of symptoms and frequency of outflow obstruction. Although Japanese and American patients also showed similar maximum LV thickness, they differed significantly with respect to the distribution of LV hypertrophy. In particular, the segmental form of HC, with hypertrophy confined to the LV apex, was more frequent in Japanese patients (i.e., apical HC, 15% in Japan vs 3% in US, p<0.0001). Giant negative T waves were also more common in Japanese patients with HC (26% vs 2%, p<0.001), including those with the apical form (64% vs. 30%, p<0.05). Each patient with apical HC had either no or only mild symptoms, and all survived. The morphologic form of nonobstructive HC with hypertrophy limited to the LV apex (apical form of HC) was 5 times more common in an unselected Japanese population. These findings document variability in the phenotypic expression of HC between countries and races, which may be due to differences in environmental factors or genetic background. Patients with the apical form of HC had a benign clinical course.
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              Subacute effusive-constrictive pericarditis.

              Robert E. W. Hancock (1971)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Cardiovasc Med J
                Journal ID (publisher-id): TOCMJ
                Title: The Open Cardiovascular Medicine Journal
                Publisher: Bentham Open
                ISSN (Electronic): 1874-1924
                Publication date (Electronic): 2 May 2011
                Publication date Collection: 2011
                Volume: 5
                Pages: 99-102
                Affiliations
                [1 ]First department of internal medicine, Nara medical university, Nara, Japan
                [2 ]Department of cardiology, Hirai hospital, Nara, Japan
                Author notes
                [* ]Address correspondence to this author at the First department of internal medicine Nara medical university, Nara, Japan, 840, Shijo-cho, Kashihara, Nara 634-8522, Japan; Tel: +81-744-223051; Fax: +81-744-229726; E-mail: satosi01@ 123456naramed-u.ac.jp
                Article
                Publisher ID: TOCMJ-5-99
                DOI: 10.2174/1874192401105010099
                PMC ID: 3111738
                PubMed ID: 21673841
                SO-VID: d3d04cff-a2b2-4544-903a-a929dffec549
                Copyright © © Okayama et al.; Licensee Bentham Open.
                License:

                This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

                History
                Date received : 27 January 2011
                Date revision received : 11 February 2011
                Date accepted : 15 February 2011
                Categories
                Subject: Article

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: magnetic resonance imaging,echocardiography,elderly.,pericardial effusion
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: magnetic resonance imaging, echocardiography, elderly., pericardial effusion

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