Echocardiography in congenital and acquired absence of the pericardium: an echocardiographic mimic of right ventricular volume overload

Abstract

The purpose of this study was to investigate the echocardiographic effects of absence of the pericardium. 5 patients with congenital complete absence of the left pericardium were studied. All had typical chest X rays, 4 had cardiac catheterization which excluded any intracardiac shunts, and one had diagnostic pneumothorax. All 5 had an enlarged right ventricular dimension (RVD): 1.9 ± 0.1 cm/m2 (normal: <1.3 cm/m2) and abnormal interventricular septal (IVS) motion (three Type A, two Type B). 16 additional patients were studied after pericardial stripping for a variety of conditions. In none was cardiopulmonary bypass used. 8 of these patients had preoperative echocardiograms; all showed normal IVS motion. After surgery RVD was large in all 16 patients, increasing from 1.0 ± 0.2 cm/m2 preoperatively to 1.7 ± 0.1 cm/m2 postoperatively, P<0.01. 14 of the 16 patients had abnormal IVS motion, 9 Type A, and 5 Type B. We conclude that absence of the pericardium results in echocardiographic abnormalities which mimic those seen in right ventricular volume overload. This may be due to altered cardiac position and motion within the thorax resulting from loss of normal pericardial restraint.