BACKGROUND: Effusive-constrictive pericarditis is an uncommon pericardial syndrome characterized by concomitant tamponade, caused by tense pericardial effusion, and constriction, caused by the visceral pericardium. We conducted a prospective study of its clinical evolution and management. METHODS: From 1986 through 2001, all patients with effusive-constrictive pericarditis were prospectively evaluated. Combined pericardiocentesis and cardiac catheterization were performed in all patients, and pericardiectomy was performed in those with persistent constriction. Follow-up ranged from 1 month to 15 years (median, 7 years). RESULTS: A total of 1184 patients with pericarditis were evaluated, 218 of whom had tamponade. Of these 218, 190 underwent combined pericardiocentesis and catheterization. Fifteen of these patients had effusive-constrictive pericarditis and were included in the study. All patients presented with clinical tamponade; however, concomitant constriction was recognized in only seven patients. At catheterization, all patients had elevated intrapericardial pressure (median, 12 mm Hg; interquartile range, 7 to 18) and elevated right atrial and end-diastolic right and left ventricular pressures. After pericardiocentesis, the intrapericardial pressure decreased (median value, -5 mm Hg; interquartile range, -5 to 0), whereas right atrial and end-diastolic right and left ventricular pressures, although slightly reduced, remained elevated, with a dip-plateau morphology. The causes were diverse, and death was mainly related to the underlying disease. Pericardiectomy was required in seven patients, all of whom had involvement of the visceral pericardium. Three patients had spontaneous resolution. CONCLUSIONS: Effusive-constrictive pericarditis is an uncommon pericardial syndrome that may be missed in some patients who present with tamponade. Although evolution to persistent constriction is frequent, idiopathic cases may resolve spontaneously. In our opinion, extensive epicardiectomy is the procedure of choice in patients requiring surgery.
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机译：背景：痉挛性收缩性心包炎是一种罕见的心包综合征，其特征是由紧绷的心包积液引起的同时压塞，以及由内脏心包引起的收缩。我们对其临床演变和管理进行了前瞻性研究。方法：从1986年至2001年，对所有脓肿性收缩性心包炎患者进行了前瞻性评估。所有患者均进行了心包穿刺术和心脏导管插入术相结合，对持续收缩的患者进行了心包切除术。随访时间为1个月至15年（中位数为7年）。结果：共评估了1184例心包炎患者，其中218例有填塞。在这218例中，有190例进行了心包穿刺和导管插入术。这些患者中有15例患有收缩性心包炎，并纳入研究。所有患者均出现临床压塞。然而，只有7例患者同时出现收缩。在置管时，所有患者的心包内压力均升高（中值12 mm Hg;四分位间距为7至18），右心房和舒张末期右，左心室压力均升高。心包穿刺后，心包内压降低（中值，-5 mm Hg;四分位间距，-5至0），而右心房和舒张末期右，左心室压力虽然略有降低，但仍然升高，呈浸润平台形态学。原因多种多样，并且死亡主要与潜在疾病有关。 7例患者均需进行心包切除术，所有患者均累及内脏心包。三名患者自发消退。结论：抽搐性收缩性心包炎是一种罕见的心包综合征，某些出现填塞的患者可能会漏诊。尽管经常发展为持续性收缩，但特发性病例可自发解决。我们认为，广泛的心外膜切除术是需要手术的患者的首选手术方法。
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