Effects of pericardiectomy on early diastolic mitral annular velocity in patients with constrictive pericarditis

Abstract

Background: In patients with constrictive pericarditis (CP), early diastolic mitral annular velocity (E') is usually normal or exaggerated due to limitation of lateral expansion by the constricting pericardium. Although pericardiectomy is the treatment of choice for CP, it is difficult to evaluate its effectiveness. Theoretically, E' may decrease after successful pericardiectomy. However, little data are available regarding the effect of pericardiectomy on E'. The purpose of this study was to assess the change in E' after pericardiectomy in patients with CP.

Methods: We studied 16 patients (12 males, mean age 62.3+/-7.0 years) with surgically confirmed CP for changes in pre-discharge Doppler parameters following pericardiectomy. CP was secondary to previous cardiac surgery in 4 patients, tuberculosis in 4 patients, radiation-induced in 1 patient, and idiopathic in 7 patients. Ten patients underwent complete pericardiectomy (62.5%). E' was measured at the septal annulus before pericardiectomy and a mean duration of 10 (+/-6) days after.

Results: E' significantly decreased from 9.2+/-2.7 cm/s to 7.4+/-2.6 after pericardiectomy (p=0.013). The mean percent change of E' after pericardiectomy was 17.9+/-25.9%. The decrement of E' was significantly higher in patients with complete pericardiectomy than in patients who underwent a partial pericardiectomy (2.7+/-2.3 vs. 0.4+/-2.1, p=0.042). Also, more than 15% decrease of E' was significantly higher in patients with improvement of symptom after pericardiectomy (9 (100.0%) vs. 3 (42.9%), p=0.019).

Conclusion: E' decreased following pericardiectomy in most of the patients with CP. The change of E' after pericardiectomy may be useful in evaluating the effectiveness of pericardiectomy.