The Journal of Thoracic and Cardiovascular Surgery, Vol 77, 511-515, Copyright © 1979 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Rheumatoid pericarditis. Clinical significance and operative management
DP Burney, CE Martin, CS Thomas, RD Fisher and HW Bender Jr
The incidence of subclinical pericarditis associated with rheumatoid
pericarditis may be as high as 50 percent, but significant impairment of
cardiac performance owing to this type of pericarditis rarely occurs. In
the past 7 years, we have encountered eight men with congestive heart
failure owing to rheumatoid pericarditis. Cardiac catheterization and
echocardiography were useful in establishing the diagnosis of pericardial
constriction. Pericardiocentesis was unsuccessful in relieving symptoms in
the three patients in whom the procedure was performed. Seven patients
underwent pericardiectomy; six had constrictive pericarditis and one
patient had an acute pericarditis with the sudden onset of cardiac
tamponade. The other patient died of cardiac tamponade prior to operation.
All patients improved after operation and have remained free of cardiac
symptoms 3 months to 4 1/2 years later. The frequent occurrence of adhesive
and obliterative pericarditis with loculated effusions suggests the need
for pericardiectomy rather than pericardiocentesis in the patient with
rheumatoid arthritis and symptomatic pericardial involvement. Immediate and
lasting relief of this unusual nonarticular manifestation of rheumatoid
arthritis can be expected after pericardiectomy.
