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Transient constrictive pericarditis: causes and natural history

John H. Haley, MD, FACC^*,*, A. Jamil Tajik, MD, FACC^*, Gordon K. Danielson, MD, FACC, Hartzell V. Schaff, MD, FACC, Sharon L. Mulvagh, MD, FACC^* and Jae K. Oh, MD, FACC^*

^* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA

View larger version (67K): [in a new window]   Figure 1 (A) Echocardiographic findings in constrictive pericarditis. Parasternal long-axis view of a 39-year-old man who presented one month after a motor vehicle accident with dyspnea, showing markedly increased pericardial thickness (arrows). (B) Follow-up echocardiogram performed one month later, showing near-normal pericardial thickness (arrows). Ao = aorta; LA = left atrium; LV = left ventricle; RV = right ventricle.

View larger version (49K): [in a new window]   Figure 2 (A) Doppler findings in constrictive pericarditis. Pulsed-wave Doppler recording of the mitral inflow velocity in the patient described in Figure 1, showing a marked increase in the mitral inflow E velocity (single arrowhead) with expiration compared with inspiration (double arrowhead). (B) Follow-up echocardiogram one month later, showing no significant increase in the mitral inflow E velocity with expiration, consistent with resolution of constrictive hemodynamics. I = inspiration; E = expiration.

View larger version (47K): [in a new window]   Figure 3 (A) Doppler findings in constrictive pericarditis. Pulsed-wave Doppler recording from the hepatic vein in the patient described in Figure 1, showing increased diastolic flow reversal with expiration (arrowhead). (B) Follow-up echocardiogram performed one month later, showing an absence of increased diastolic flow reversals with expiration (double arrowhead), consistent with resolution of constrictive hemodynamics. I = inspiration; E = expiration.

View larger version (100K): [in a new window]   Figure 4 (A) Pericardial thickening in constrictive pericarditis. Cardiac magnetic resonance imaging in a 69-year-old man who presented with idiopathic pericarditis. Note marked thickening of the pericardium over much of the right heart and extending over the anterior portion of the left ventricle (arrow). (B) Resolution of pericardial thickening in transient constrictive pericarditis. Follow-up imaging of the heart performed in the same patient two months later demonstrates normal thickness of the pericardium (arrow).

View larger version (23K): [in a new window]   Figure 5 Causes of transient and nontransient constrictive pericarditis. Comparison of etiologic factors in transient constrictive physiology with those reported in a recent study of 135 patients requiring pericardiectomy for treatment of constrictive pericarditis from 1985 through 1995 at Mayo Clinic (11). CV = cardiovascular; CVD = collagen vascular disease.