Journal of Perioperative Echocardiography

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VOLUME 7 , ISSUE 1 ( January-June, 2019 ) > List of Articles


Perioperative Concerns and Management of Patients with Right Atrial Thrombus in Chronic Constrictive Pericarditis Undergoing Pericardiectomy: A Case Series

Srinath Damodaran, Imran Bhat, Sunder Negi, Maramreddy Revanth, Vinay Upadhyay

Keywords : Cardiopulmonary bypass, Constrictive pericarditis, Echocardiography, Right atrium thrombus

Citation Information : Damodaran S, Bhat I, Negi S, Revanth M, Upadhyay V. Perioperative Concerns and Management of Patients with Right Atrial Thrombus in Chronic Constrictive Pericarditis Undergoing Pericardiectomy: A Case Series. J Perioper Echocardiogr 2019; 7 (1):6-11.

DOI: 10.5005/jp-journals-10034-1094

License: CC BY-NC 4.0

Published Online: 31-07-2020

Copyright Statement:  Copyright © 2019; The Author(s).


Chronic constrictive pericarditis (CCP) is a condition in which thickened, noncompliant pericardium encases heart structures. Association of right atrial (RA) thrombus in CCP imparts some challenges during the perioperative period. Perioperative echocardiography plays a vital role in managing this group of patients. This case series highlights the importance of perioperative echocardiography in managing the patients who had CCP with RA thrombus.

  1. Chen R, Lai CP. Clinical characteristics and treatment of constrictive pericarditis in Taiwan. Circ J 2005;69(4):458–460. DOI: 10.1253/circj.69.458.
  2. DeValeria PA, Baumgartner WA, Casale AS, et al. Current indications, risks, and outcome after pericardiectomy. Ann Thorac Surg 1991;52(2):219–224. DOI: 10.1016/0003-4975(91)91339-w.
  3. Troughton RW, Asher CR, Klein AL. Pericarditis. Lancet 2004;363(9410):717–727. DOI: 10.1016/S0140-6736(04)15648-1.
  4. Maisch B, Seferovic PM, Ristic AD, et al. Guidelines on the diagnosis and management of pericardial diseases executive summary; the task force on the diagnosis and management of pericardial diseases of the European Society of Cardiology. Eur Heart J 2004;25(7):587–610. DOI: 10.1016/j.ehj.2004.02.002.
  5. Little WC, Freeman GL. Pericardial disease. Circulation 2006;113(12):1622–1632. DOI: 10.1161/CIRCULATIONAHA.105. 561514.
  6. Bertog SC, Thambidorai SK, Parakh K, et al. Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy. J Am Coll Cardiol 2004;43(8):1445–1452. DOI: 10.1016/j.jacc.2003.11.048.
  7. Klein AL, Abbara S, Agler DA, et al. American society of echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the society for cardiovascular magnetic resonance and society of cardiovascular computed tomography. J Am Soc Echocardiogr 2013;26(9):965–1012.e15. DOI: 10.1016/j.echo.2013.06.023.
  8. Bogaert J, Francone M. Pericardial disease: value of CT and MR imaging. Radiology 2013;267(2):340–356. DOI: 10.1148/radiol.13121059.
  9. Frank H, Globits S. Magnetic resonance imaging evaluation of myocardial and pericardial disease. J Magn Reson Imaging 1999;10(5):617–626. DOI: 10.1002/(sici)1522-2586(199911);2-z.
  10. Burke A, Jeudy J Jr, Virmani R. Cardiac tumours: an update—cardiac tumours. Heart 2008;94(1):117–123. DOI: 10.1136/hrt.2005.078576.
  11. Restrepo CS, Largoza A, Lemos DF, et al. CT and MR imaging findings of benign cardiac tumors. Curr Probl Diagn Radiol 2005;34(1):12–21. DOI: 10.1067/j.cpradiol.2004.10.002.
  12. Ogren M, Bergqvist D, Eriksson H, et al. Prevalence and risk of pulmonary embolism in patients with intracardiac thrombosis: a population-based study of 23 796 consecutive autopsies. Eur Heart J 2005;26(11):1108–1114. DOI: 10.1093/eurheartj/ehi130.
  13. London AR, Runge PJ, Balsam RF, et al. Large right atrial thrombi surrounding permanent transvenous pacemakers. Circulation 1969;40(5):661–664. DOI: 10.1161/01.cir.40.5.661.
  14. Chakko S, Richards FIII. Right-sided cardiac thrombi and pulmonary embolism. Am J Cardiol 1987;59(1):195–196. DOI: 10.1016/S0002-9149(87)80114-5.
  15. Pliam MB, McGough EC, Nixon W, et al. Right atrial ball-valve thrombus: a complication of central venous alimentation in an infant. J Thorac Cardiovasc Surg 1979;78(4):579–582. DOI: 10.1016/S0022-5223(19)38087-0.
  16. Yilmaz M, Gurlertop Y, Erdogan F. Right atrial thrombus following closure of an atrial septal defect. Heart 2003;89(7):726. DOI: 10.1136/heart.89.7.726.
  17. Burns KE, McLaren A. Catheter-related right atrial thrombus and pulmonary embolism: a case report and systematic review of the literature. Can Respir J 2009;16(5):163–165. DOI: 10.1155/2009/751507.
  18. Akiyama K, Nakae S, Imamura E, et al. A case of right atrial thrombus associated with constrictive pericarditis. Rinshou Kyoubu Geka 1984;4(5):607–612.
  19. Fowler N. Constrictive pericarditis: new aspects. Am J Cardiol 1982;50(5):1014–1017. DOI: 10.1016/0002-9149(82)90410-6.
  20. Pahade A, Tewari P. Major vessel venous thrombosis in patients of post tubercular chronic constrictive pericarditis undergoing pericardiectomy: a rare scenario. Ann Card Anaesth 2017;20(3): 348–350. DOI: 10.4103/aca.ACA_77_16.
  21. Manning WJ, Weintraub RM, Waksmonski CA, et al. Accuracy of transesophageal echocardiography for identifying left atrial thrombi: a prospective, intraoperative study. Ann Intern Med 1995;123(11):817–822. DOI: 10.7326/0003-4819-123-11-199512010- 00001.
  22. Panidis IP, Kotler MN, Mintz GS, et al. Clinical and echocardiographic features of right atrial masses. Am Heart J 1984;107(4):745–758. DOI: 10.1016/0002-8703(84)90324-7.
  23. Felner JM, Churchwell AL, Murphy DA. Right atrial thromboemboli: Clinical, echocardiographic and pathophysiologic manifestations. J Am Coll Cardiol 1984;5(5):1041–1051. DOI: 10.1016/s0735-1097(84)80069-8.
  24. Yarnal JR, Smiley WH. Right atrial mass simulated echocardiographically by a swan-Ganz catheter. Chest 1978;74(4):478–479. DOI: 10.1378/chest.74.4.478-a.
  25. Goldhaber SZ, Nagel JS, Theard M, et al. Treatment of right atrial thrombus with urokinase. Am Heart J 1988;115(4):894–897. DOI: 10.1016/0002-8703(88)90894-0.
  26. Todoran TM, Sobieszczyk PS, Levy MS, et al. Percutaneous extraction of right atrial mass using the AngioVac aspiration system. J Vasc Interv Radiol 2011;22(9):1345–1347. DOI: 10.1016/j.jvir.2011.04.004.
  27. Sakhuja R, Gandhi S, Rogers RK, et al. A novel endovenous approach for treatment of massive central venous or pulmonary arterial thrombus, mass, or vegetation: the AngioVac suction cannula and circuit [abstract]. J Am Coll Cardiol 2011;57(14):E1535. DOI: 10.1016/S0735-1097(11)61535-0.
  28. ElMallah W, Kalra N, Wiisanen M, et al. AngioVac catheter extractions: a novel technique for cardiac mass extraction. Learning curve and predictors of success [abstract]. Catheter Cardiovasc Interv 2014;83(Suppl S1):S117.
  29. Kudaka M, Koja K, Kuniyoshi Y, et al. A case report of surgical treatment of constrictive pericarditis with coronary artery disease. Nihon Kyobu Geka Gakkai Zasshi 1997;45(11):1880–1883.
  30. Zengbin F, Zhiwei L, Chaoman Z. Coronary heart disease complicated with chronic constrictive pericarditis: a case report. Chin J Clin Thorac Cardiovasc Surg 2006;13(3):63.
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