Constrictive Pericarditis

2D Echocardiography and Doppler evaluation can provide valuable clues to the presence of constrictive pericarditis.

M-Mode and 2-0 Echocardiographic Features
1) Pericardial Thickness-Increased echocardiographic density behind the posterior wall suggests pericardial thickening, but echocardiographic measurement of precise pericardial thickness may be inaccurate. TEE provides more accurate assessment of pericardial thickness.

Fig. (a): Two Dimensional echocardiographic image showing PLAX view with thickened pericardium posteriorly.

Fig.  (b): Pour chamber view showing thickened pericardium at the apex with mild pericardial effusion.

i)Mild atrial enlargement with normal sized left ventricle.

ii) Dilation of the vena cava

iii) Flattening of LV endocardia1 motion in mid and late diastole.

iv) Septa1 bounce.

vi)  Premature opening of the pulmonary valve. Doppler Echocardiographic Features.

2) A respiratory variation of 25 per cent or greater in mitral inflow E velocity 40 per cent or greater in bicuspid inflow E velocity.

Dilated IVC - M-Mode across IVC showing dilated
W C with decreased inspiratory
collapse

3) Increased diastolic flow reversal with expiration in the hepatic vein. Up do 20 per cent of patients with constrictive pericarditis demonstrate ldss than 25 per cent of respiratory variation in rnitral E velocity, (1) btcause of mixed constriction and restriction (2) marked increase of atdial pressures.

Pulse wave Doppler across hepatic vein showing increased diastolic flow
reversal

Rule out other causes similar respiratory variation in mitral inflow velocity

1) Acute dilatation of heart

2) Pulmonary embolism

3) RV infarct

4) Pleural effusion

5) COPD