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Calcific Constrictive Pericarditis: Is It Still with Us?

Lieng H. Ling, MBBS, MRCP; Jae K. Oh, MD; Jerome F. Breen, MD; Hartzell V. Schaff, MD; Gordon K. Danielson, MD; Douglas W. Mahoney, MSc; James B. Seward, MD; and A. Jamil Tajik, MD
[+] Article, Author, and Disclosure Information

From the Mayo Clinic and Mayo Foundation, Rochester, Minnesota.

Grant Support: Dr. Ling was supported by a Faculty Development Program Scholarship from the National University Hospital, Singapore, and by the Mayo Foundation.

Requests for Single Reprints: Jae K. Oh, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Requests To Purchase Bulk Reprints (minimum, 100 copies): Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Dr. Ling: Department of Medicine, National University of Singapore, Kent Ridge Crescent, Singapore 119074.

Drs. Oh, Breen, Schaff, Danielson, Seward, and Tajik and Mr. Mahoney: Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Author Contributions: Conception and design: L.H. Ling, J.K. Oh, A.J. Tajik.

Analysis and interpretation of the data: L.H. Ling, J.K. Oh, J.F. Breen, D.W. Mahoney.

Drafting of the article: L.H. Ling.

Critical revision of the article for important intellectual content: J.K. Oh, G.K. Danielson, H.V. Schaff, D.W. Mahoney, A.J. Tajik.

Final approval of the article: J.K. Oh, J.F. Breen, H.V. Schaff, G.K. Danielson, D.W. Mahoney, J.B. Seward, A.J. Tajik.

Provision of study materials or patients: G.K. Danielson, H.V. Schaff.

Ann Intern Med. 2000;132(6):444-450. doi:10.7326/0003-4819-132-6-200003210-00004
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The presence of pericardial calcification on radiography strongly suggests constrictive pericarditis in patients with symptoms of heart failure (12). In a 1959 study, calcification was documented in up to 90% of all cases (3), usually after tuberculous pericarditis. However, because of the decrease in rates of tuberculosis and the increase in iatrogenic causes of constriction (45), calcific constrictive pericarditis is believed to be extremely uncommon in the United States; it is now reported in as few as 5% of all cases of constrictive pericarditis (5). We reviewed our experience with pericardial constriction during the past decade and analyzed the clinical, diagnostic, and surgical profiles of patients with calcific constrictive pericarditis to determine the relevance of pericardial calcification in the current practice of cardiovascular medicine.

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Grahic Jump Location
Figure 1.
Radiographs of patients with calcification. Top.Middle.Bottom.

Posteroanterior chest radiograph showing circumferential pericardial calcification in a patient with constrictive pericarditis of indeterminate cause. Left lateral chest radiograph showing extensive pericardial calcification, predominantly over the right ventricle. Left lateral projection of a patient with a permanent transvenous pacemaker and marked calcification of both atrioventricular grooves.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Late survival among 119 patients with constrictive pericarditis, stratified by presence or absence of radiologic calcification.nn

The solid line represents no calcification ( = 90); the dashed line represents calcification on chest radiograph ( = 29). Values expressed with a plus/minus sign are the mean 10-year event rates ± SE.

Grahic Jump Location




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Summary for Patients

Calcific Constrictive Pericarditis

The summary below is from the full report titled “Calcific Constrictive Pericarditis: Is It Still with Us?” It is in the 21 March 2000 issue of Annals of Internal Medicine (volume 132, pages 444-450). The authors are L.H. Ling, J.K. Oh, J.F. Breen, H.V. Schaff, G.K. Danielson, D.W. Mahoney, J.B. Seward, and A.J. Tajik.


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