RESUMEN
The authors report a case of constrictive pericarditis occurring two years after surgical repair of an atrial septal defect in a 37 year-old-man. The diagnosis was made by right heart catheterisation and magnetic resonance imaging. The special feature of this clinical case was the exclusive localisation of the fibrosis on the visceral pericardium or epicarditis. The outcome was favourable after resection of the visceral pericardium respecting the parietal pericardium. Magnetic resonance imaging and right heart catheterisation performed 6 months after surgery were normal. Constrictive pericarditis is a classical complication of cardiac surgery but relatively rare after repair of an atrial septal defect. Isolated involvement of the visceral pericardium is rare and allows surgical correction by exclusive epicardectomy respecting the parietal pericardium.
Asunto(s)
Defectos del Tabique Interatrial/cirugía , Pericarditis Constrictiva/etiología , Adulto , Cateterismo Cardíaco , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Pericardiectomía , Pericarditis Constrictiva/diagnóstico , Pericarditis Constrictiva/cirugía , Pericardio/patología , Pericardio/cirugía , Complicaciones Posoperatorias , Resultado del TratamientoRESUMEN
The authors report the case of a patient admitted to hospital for bilateral phlebitis of the lower limbs, associated with an atrial septal defect. The presence of significant pulmonary hypertension accounted for the paradoxical embolism by inversion of the intracardiac shunt. No recurrence has been observed with a follow-up of six months on anticoagulant treatment.
Asunto(s)
Embolia/etiología , Aneurisma Cardíaco/complicaciones , Defectos del Tabique Interatrial/complicaciones , Embolia Pulmonar/etiología , Embolia/diagnóstico , Femenino , Aneurisma Cardíaco/fisiopatología , Defectos del Tabique Interatrial/fisiopatología , Tabiques Cardíacos , Humanos , Persona de Mediana EdadAsunto(s)
Acebutolol/efectos adversos , Fiebre/inducido químicamente , Adulto , Femenino , Humanos , Factores de TiempoRESUMEN
The echocardiographic appearances of a patient with a rare congenital malformation, interatrial septal aneurysm (IASA) associated with a hemodynamically significant left-to-right shunt, are described. A 52 year old man with Noonan's syndrome was admitted to hospital for atrial flutter with right heart failure, which, on investigation, led to the diagnosis of a rare type of atrial septal defect; 2D echocardiography showed an isolated aneurysm of the interatrial septum; cardiac catheterisation demonstrated a significant left-to-right (5 volumes of oxygen per 100 ml). The patient underwent surgery which confirmed the presence of a multiperforated aneurysm of the interatrial septum in the region of the fossa ovalis. This abnormality was resected and the interatrial defect closed; there were no postoperative complications and the cardiomegaly regressed significantly. The authors underline the M mode and 2D appearances of this condition; although it may be difficult on M mode examination to distinguish an IASA from other conditions giving rise to mobile intra-right atrial echos, such as Chiari's malformation, tricuspid valve vegetations, intraatrial tumour or thrombus or Eustachian valve, 2D examination using different incidences and contrast injections generally confirms the diagnosis. Surgery is often necessary after the detection of this echocardiographic abnormality: the surgical indications are described.