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Redefining Effusive-Constrictive Pericarditis with Echocardiography
Pieter van der Bijl,Philip Herbst,Anton F. Doubell 한국심초음파학회 2016 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.24 No.4
Background: Effusive-constrictive pericarditis (ECP) is traditionally diagnosed by using the expensive and invasive techniqueof direct pressure measurements in the pericardial space and the right atrium. The aim of this study was to assess the diagnosticrole of echocardiography in tuberculous ECP. Methods: Intrapericardial and right atrial pressures were measured pre- and post-pericardiocentesis, and right ventricular andleft ventricular pressures were measured post-pericardiocentesis in patients with tuberculous pericardial effusions. Echocardiographywas performed post-pericardiocentesis. Traditional, pressure-based diagnostic criteria were compared with post-pericardiocentesissystolic discordance and echocardiographic evidence of constriction. Results: Thirty-two patients with tuberculous pericardial disease were included. Sixteen had ventricular discordance (invasivelymeasured), 16 had ECP as measured by intrapericardial and right atrial invasive pressure measurements and 17 had ECP determinedechocardiographically. The sensitivity and specificity of pressure-guided measurements (compared with discordance) forthe diagnosis of ECP were both 56%. The positive and negative predictive values were both 56%. The sensitivity of echocardiography(compared with discordance) for the diagnosis of ECP was 81% and the specificity 75%, while the positive and the negativepredictive values were 76% and 80%, respectively. Conclusion: Echocardiography shows a better diagnostic performance than invasive, pressure-based measurements for the diagnosisof ECP when both these techniques are compared with the gold standard of invasively measured systolic discordance.
A "Vanishing”, Tuberculous, Pericardial Effusion
Jacques Liebenberg,Pieter van der Bijl 대한심장학회 2016 Korean Circulation Journal Vol.46 No.6
We present an iatrogenic, pleuro-pericardial connection resulting from pericardiocentesis of a large, tuberculous, pericardial effusion. Recognition of this situation is paramount when one is unable to aspirate pericardial fluid after a successful, initial puncture. Such knowledge will help prevent myocardial or coronary artery injury with further attempts at aspiration.