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      Pericarditis constrictiva crónica calcificada idiopática (concretio cordis) Translated title: Idiopathic calcific chronic constrictive pericarditis (concretio cordis)

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          Abstract

          Resumen La pericarditis constrictiva es una enfermedad poco frecuente que resulta de la pérdida de la elasticidad normal del saco pericárdico y la consiguiente cicatrización. Comprende diversas etiologías, pero en un gran porcentaje de los casos es diagnosticada como idiopática. Sus manifestaciones suelen ser crónicas, aunque sus variantes incluyen constricción subaguda, transitoria y oculta. Se presenta el caso de un paciente masculino de 53 años de edad con deterioro de su clase funcional asociado a disnea, frote pericárdico y hallazgos radiológicos de calcificación pericárdica, requiriendo pericardiectomía total.

          Translated abstract

          Abstract Constrictive pericarditis is an uncommon condition resulting from loss of normal elasticity pericardial sac and consequent healing. Although a large percentage of cases are diagnosed as idiopathic. That pathology comprises various etiologies. Its manifestations are usually chronic, but variants include subacute and transient constriction. We present the case of a male patient of 53 years who presented functional class deterioration manifested by dyspnea, pericardial rub and radiological findings confirming pericardial calcification requiring total pericardiectomy.

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          Most cited references15

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          Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy.

          We sought to determine the association of etiology of constrictive pericarditis (CP), pericardial calcification (CA), and other clinical variables with long-term survival after pericardiectomy. Constrictive pericarditis is the result of a spectrum of primary cardiac and noncardiac conditions. Few data exist on the cause-specific survival after pericardiectomy. The impact of CA on survival is unclear. A total of 163 patients who underwent pericardiectomy for CP over a 24-year period at a single surgical center were studied. Constrictive pericarditis was confirmed by the surgical report. Vital status was obtained from the Social Security Death Index. Etiology of CP was idiopathic in 75 patients (46%), prior cardiac surgery in 60 patients (37%), radiation treatment in 15 patients (9%), and miscellaneous in 13 patients (8%). Median follow-up among survivors was 6.9 years (range 0.8 to 24.5 years), during which time there were 61 deaths. Perioperative mortality was 6%. Idiopathic CP had the best prognosis (7-year Kaplan-Meier survival: 88%, 95% confidence interval [CI] 76% to 94%) followed by postsurgical (66%, 95% CI 52% to 78%) and postradiation CP (27%, 95% CI 9% to 58%). In bootstrap-validated proportional hazards analyses, predictors of poor overall survival were prior radiation, worse renal function, higher pulmonary artery systolic pressure (PAP), abnormal left ventricular (LV) systolic function, lower serum sodium level, and older age. Pericardial calcification had no impact on survival. Long-term survival after pericardiectomy for CP is related to underlying etiology, LV systolic function, renal function, serum sodium, and PAP. The relatively good survival with idiopathic CP emphasizes the safety of pericardiectomy in this subgroup.
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            Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardiectomy.

            The clinical spectrum of constrictive pericarditis (CP) has been affected by a change in incidence of etiological factors. We sought to determine the impact of these changes on the outcome of pericardiectomy. The contemporary spectrum of CP in 135 patients (76% male) evaluated at the Mayo Clinic from 1985 to 1995 was compared with that of a historic cohort. Notable trends were an increasing frequency of CP due to cardiac surgery and mediastinal radiation and presentation in older patients (median age, 61 versus 45 years). Perioperative mortality decreased (6% versus 14%, P = 0.011), but late survival was inferior to that of an age- and sex-matched US population (57+/-8% at 10 years). The long-term outcome was predicted independently by 3 variables in stepwise logistic regression analyses: (1) age, (2) NYHA class, and most powerfully, (3) a postradiation cause. Of 90 late survivors in whom functional class could be determined, functional status had improved markedly (2.6+/-0.7 at baseline versus 1.5+/-0.8 at latest follow-up [P<0.0001]), with 83% being free of clinical symptoms. The evolving profile of CP, with increasingly older patients and those with radiation-induced disease in the past decade, significantly affects postoperative prognosis. Long-term results of pericardiectomy are disappointing for some patient groups, especially those with radiation-induced CP. By contrast, surgery alleviates or improves symptoms in the majority of late survivors.
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              Risk of constrictive pericarditis after acute pericarditis.

              Constrictive pericarditis (CP) is considered a rare, dreaded possible complication of acute pericarditis. Nevertheless, there is a lack of prospective studies that have evaluated the specific risk according to different etiologies. The aim of this study is to evaluate the risk of CP after acute pericarditis in a prospective cohort study with long-term follow-up. From January 2000 to December 2008, 500 consecutive cases with a first episode of acute pericarditis (age, 51±16 years; 270 men) were prospectively studied to evaluate the evolution toward CP. Etiologies were viral/idiopathic in 416 cases (83.2%), connective tissue disease/pericardial injury syndromes in 36 cases (7.2%), neoplastic pericarditis in 25 cases (5.0%), tuberculosis in 20 cases (4.0%), and purulent in 3 cases (0.6%). During a median follow-up of 72 months (range, 24 to 120 months), CP developed in 9 of 500 patients (1.8%): 2 of 416 patients with idiopathic/viral pericarditis (0.48%) versus 7 of 84 patients with a nonviral/nonidiopathic etiology (8.3%). The incidence rate of CP was 0.76 cases per 1000 person-years for idiopathic/viral pericarditis, 4.40 cases per 1000 person-years for connective tissue disease/pericardial injury syndrome, 6.33 cases per 1000 person-years for neoplastic pericarditis, 31.65 cases for 1000 person-years for tuberculous pericarditis, and 52.74 cases per 1000 person-years for purulent pericarditis. CP is a relatively rare complication of viral or idiopathic acute pericarditis (<0.5%) but, in contrast, is relatively frequent for specific etiologies, especially bacterial.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                cesm
                CES Medicina
                CES Med.
                Universidad CES (Medellín, Antioquia, Colombia )
                0120-8705
                December 2016
                : 30
                : 2
                : 217-224
                Affiliations
                [02] Medellín orgnameHospital General de Medellín Colombia hernan-aguirre@ 123456hotmail.com
                [03] Chia orgnameUniversidad de la Sabana Colombia
                [04] Medellín orgnameUniversidad de Antioquia Colombia
                [01] orgnameCentros especializados de San Vicente Fundación
                Article
                S0120-87052016000200010
                3f141450-d181-4b46-95da-f2a44a21aa54

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 10 June 2016
                : 27 December 2015
                : 11 September 2016
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 15, Pages: 8
                Product

                SciELO Colombia


                Constrictive pericarditis,Concretio cordis,Total pericardiectomy,Pericarditis constrictiva,Pericardiectomía

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