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Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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32. Cardiovascular Nursing
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CLEAR FILTERS
Constrictive Pericarditis: still a difficult diagnosis
Session:
Painel 10 - Doença Valvular 4
Speaker:
Isabel Cardoso
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
18. Pericardial Disease
Subtheme:
18.2 Pericardial Disease – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Isabel Gonçalves Machado Cardoso; Luisa Moura Branco; Ana Galrinho; Pedro Coelho; Nuno Banazol; Duarte Cacela; Tânia Branco Mano; João Pedro Reis; Vera Ferreira; Alexandra Castelo; André Grazina; José Miguel Viegas; Pedro Garcia Brás; Fernanda Varela Gameiro; José Fragata; Rui Cruz Ferreira
Abstract
<p><u>Introduction</u></p> <p>Constrictive pericarditis (CP) is a rare disorder. Its diagnosis relies on a high clinical suspicion, echocardiographic evaluation and hemodynamic catheterization.</p> <p><u>Objective</u></p> <p>To characterize the population diagnosed with CP between January 2008 and March 2019 in a tertiary hospital and evaluate the acuity of different imaging techniques.</p> <p><u>Methods</u></p> <p>Retrospective analysis of 32 patients (P) diagnosed with CP between January 2008 and March 2019.</p> <p><u>Results</u></p> <p>32P, 25 (78.1%) male, mean age 53 ± 17.8 years. The most frequent etiology was idiopathic (20P, 62.5%), followed by previous idiopathic acute pericarditis (4P, 12.5%), tuberculosis (TB) (4P, 12.5%), radiotherapy (2P, 6.2%), neoplastic (1P, 3.1%) and traumatic (1P, 3.19%); 4P (12.5%) were diagnosed as effusive-constrictive pericarditis. Congestive heart failure was present in 26P (81.3%), with preserved left ventricular (LV) ejection fraction in 27P (84.4%): NYHA 3 (18P, 50%), NYHA 2 (13P, 40.6%). Duration of symptoms before diagnosis was in average 19.5 ± 19.57 months. Hypertension was present in 13P (40.6 %), chronic kidney disease in 7P (21.9%), chronic obstructive pulmonary disease (5P, 15.6%), valvular heart disease (5P, 15.6%). Many P had supraventricular arrhythmias: atrial fibrillation (12P, 37.5%) and atrial flutter (4P, 12.5%). Echocardiographic evaluation showed pericardial thickening (21P, 80.8%), septal bounce in 18P (62.1%), respiratory variation of the mitral peak E velocity > 25% in 14P (43.8%), restrictive filling pattern of LV in 15P (51.7%), left atrium dilation in 16P (55.2%), right atrium dilatation in 12P (41.4%), significant mitral insufficiency in 5P (15.6%) and significant tricuspid insufficiency in 7P (21.9%). Hemodynamic catheterization revealed right ventricular and left ventricular diastolic pressure equalization in 17P (53.1%) and square root sign in 9P (28.1<em>%).</em> Magnetic resonance was performed in 9P, 5P (55.6%) had signs of constriction, computed tomography (performed in 17P), showed calcifications in 9P (45.0%). Pericardiectomy was performed in 25P (78.1%): Most of the calcified/thickened pericardium was tried to be explanted. In one the diagnosis was made only in the operating room. Total mortality up to present is 28.0% (9P). Perioperative mortality 12.5% (4P), reduced ejection fraction (rEF) was significantly associated with higher mortality rate (p= 0.019, odds ratio 17.6, CI 1.602-193.391).</p> <p><u>Conclusions</u></p> <p>Most cases of CP in our series are idiopathic or TB. The most frequent diagnostic aspects were pericardial thickening in echocardiography, septal bounce, LV restrictive filling pattern and biatrial dilation. In more than half there was diastolic pressure equalization. The majority of patients was submitted to pericardiectomy, with a perioperative mortality of 12.5% and total mortality of 28.0%, rEF was the only risk factor significantly associated with mortality. </p> <p> </p> <p> </p>
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