Left Atrial Enlargement in Chronic Constrictive Pericarditis: Clinical Implications

Abstract

Summary: Chronic constrictive pericarditis is a well known condition; its clinical, hemodynamic and radiological features have been described in detail in the literature. The radiological findings include a small or slightly enlarged heart, pericardial calcification, relatively clear lungs fields, diminshed contractions on fluoroscopy and paradoxical response of cardiac silhouette to vals alva manouvere. Four consecutive cases of shronic constrictive pericarditis were seen and studied in the haemodynamic laboratory at the Jinnah Postgraduate Medical Centre, Karachi. All four cases were found to have evidence of severe pericardial constriction on haemodynamic studies and the diagnosis was confirmed on surgery. All four cases had mod erate left atrial enlargement on x-ray and flouroscopic examination, repeat x-ray six weeks post-operatively showed regression of left atrium to normal size. Its clinical implications, especially the problem it poses to diagnose this condition from mitral valve disease are discussed in detail in this paper. A possible mechanism for left atrial enlargement has been discussed.