Echocardiographic diagnosis of total or left congenital pericardial absence with positional change

Min Jeong Kim, Hyung Kwan Kim, Ji Hyun Jung, Yeonyee E. Yoon, Hack Lyoung Kim, Jun Bin Park, Seung Pyo Lee, Yong Jin Kim, Goo Young Cho, Dae Won Sohn, Jae Kuen Oh

Research output: Contribution to journalArticle

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Abstract

Objectives Congenital absence of the pericardium (CAP) is often confused with other conditions presenting with right ventricular dilatation and usually warrants CT or cardiac MR (CMR) to confirm. It would be desirable to have more specific echocardiographic criteria to provide a conclusive diagnosis. Methods 11 patients who were diagnosed with CAP (four patients with total CAP) based on CT/CMR were consecutively enrolled. Thirteen patients with atrial septal defect (ASD) and 16 normal subjects served as controls. To investigate spatial changes of heart in the thoracic cavity in CAP, following echocardiographic measurements were made in the left and right decubitus positions: the angle between the ultrasound beam and the left ventricular posterior wall (Angle- PW) in end-diastole at the parasternal long axis, and the distance between the chest wall and the most distal part of the left ventricular posterior wall (Distance- PW) at the parasternal mid-ventricular short axis. Results Angle- PW in patients with CAP were significantly greater than in those with ASD (100.1±12.5° vs 74.5±8.6°, p<0.017) or in normal subjects (100.1±12.5° vs 69.9±7.6°, p<0.017) at the left decubitus, and the difference in Angle- PW according to posture (left vs right) was significantly greater in CAP compared with the other groups (CAP 20.7±12.7°, ASD 0.31±1.80°, normal 0.31±1.40°, all p<0.017). The differences in Distance- PW according to patient position (CAP 2.43±0.77°, ASD 0.42±0.45°, normal 0.26±0.55°) or cardiac cycle in each position (left: CAP 1.60±0.76°, ASD 0.41±0.27°, normal 0.17±0.12°; right: CAP 0.70±0.32°, ASD 0.22±0.19°, normal 0.22±0.13°) were significantly higher in the CAP group than in the other groups (all p<0.017). Conclusions Patients with CAP have dynamic alteration in cardiac position depending on posture, which is not observed in ASD or in normal controls. Hence, total or left-sided CAP can be reliably diagnosed with positional changes during routine echocardiography.

Original languageEnglish (US)
Pages (from-to)1203-1209
Number of pages7
JournalHeart
Volume103
Issue number15
DOIs
StatePublished - Aug 1 2017

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Pericardium
Atrial Heart Septal Defects
Posture
Thoracic Cavity
Diastole
Thoracic Wall
Echocardiography
Dilatation

Keywords

  • congenital pericardial absence
  • echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Echocardiographic diagnosis of total or left congenital pericardial absence with positional change. / Kim, Min Jeong; Kim, Hyung Kwan; Jung, Ji Hyun; Yoon, Yeonyee E.; Kim, Hack Lyoung; Park, Jun Bin; Lee, Seung Pyo; Kim, Yong Jin; Cho, Goo Young; Sohn, Dae Won; Oh, Jae Kuen.

In: Heart, Vol. 103, No. 15, 01.08.2017, p. 1203-1209.

Research output: Contribution to journalArticle

Kim, MJ, Kim, HK, Jung, JH, Yoon, YE, Kim, HL, Park, JB, Lee, SP, Kim, YJ, Cho, GY, Sohn, DW & Oh, JK 2017, 'Echocardiographic diagnosis of total or left congenital pericardial absence with positional change', Heart, vol. 103, no. 15, pp. 1203-1209. https://doi.org/10.1136/heartjnl-2016-310870
Kim, Min Jeong ; Kim, Hyung Kwan ; Jung, Ji Hyun ; Yoon, Yeonyee E. ; Kim, Hack Lyoung ; Park, Jun Bin ; Lee, Seung Pyo ; Kim, Yong Jin ; Cho, Goo Young ; Sohn, Dae Won ; Oh, Jae Kuen. / Echocardiographic diagnosis of total or left congenital pericardial absence with positional change. In: Heart. 2017 ; Vol. 103, No. 15. pp. 1203-1209.
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title = "Echocardiographic diagnosis of total or left congenital pericardial absence with positional change",
abstract = "Objectives Congenital absence of the pericardium (CAP) is often confused with other conditions presenting with right ventricular dilatation and usually warrants CT or cardiac MR (CMR) to confirm. It would be desirable to have more specific echocardiographic criteria to provide a conclusive diagnosis. Methods 11 patients who were diagnosed with CAP (four patients with total CAP) based on CT/CMR were consecutively enrolled. Thirteen patients with atrial septal defect (ASD) and 16 normal subjects served as controls. To investigate spatial changes of heart in the thoracic cavity in CAP, following echocardiographic measurements were made in the left and right decubitus positions: the angle between the ultrasound beam and the left ventricular posterior wall (Angle- PW) in end-diastole at the parasternal long axis, and the distance between the chest wall and the most distal part of the left ventricular posterior wall (Distance- PW) at the parasternal mid-ventricular short axis. Results Angle- PW in patients with CAP were significantly greater than in those with ASD (100.1±12.5° vs 74.5±8.6°, p<0.017) or in normal subjects (100.1±12.5° vs 69.9±7.6°, p<0.017) at the left decubitus, and the difference in Angle- PW according to posture (left vs right) was significantly greater in CAP compared with the other groups (CAP 20.7±12.7°, ASD 0.31±1.80°, normal 0.31±1.40°, all p<0.017). The differences in Distance- PW according to patient position (CAP 2.43±0.77°, ASD 0.42±0.45°, normal 0.26±0.55°) or cardiac cycle in each position (left: CAP 1.60±0.76°, ASD 0.41±0.27°, normal 0.17±0.12°; right: CAP 0.70±0.32°, ASD 0.22±0.19°, normal 0.22±0.13°) were significantly higher in the CAP group than in the other groups (all p<0.017). Conclusions Patients with CAP have dynamic alteration in cardiac position depending on posture, which is not observed in ASD or in normal controls. Hence, total or left-sided CAP can be reliably diagnosed with positional changes during routine echocardiography.",
keywords = "congenital pericardial absence, echocardiography",
author = "Kim, {Min Jeong} and Kim, {Hyung Kwan} and Jung, {Ji Hyun} and Yoon, {Yeonyee E.} and Kim, {Hack Lyoung} and Park, {Jun Bin} and Lee, {Seung Pyo} and Kim, {Yong Jin} and Cho, {Goo Young} and Sohn, {Dae Won} and Oh, {Jae Kuen}",
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T1 - Echocardiographic diagnosis of total or left congenital pericardial absence with positional change

AU - Kim, Min Jeong

AU - Kim, Hyung Kwan

AU - Jung, Ji Hyun

AU - Yoon, Yeonyee E.

AU - Kim, Hack Lyoung

AU - Park, Jun Bin

AU - Lee, Seung Pyo

AU - Kim, Yong Jin

AU - Cho, Goo Young

AU - Sohn, Dae Won

AU - Oh, Jae Kuen

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Objectives Congenital absence of the pericardium (CAP) is often confused with other conditions presenting with right ventricular dilatation and usually warrants CT or cardiac MR (CMR) to confirm. It would be desirable to have more specific echocardiographic criteria to provide a conclusive diagnosis. Methods 11 patients who were diagnosed with CAP (four patients with total CAP) based on CT/CMR were consecutively enrolled. Thirteen patients with atrial septal defect (ASD) and 16 normal subjects served as controls. To investigate spatial changes of heart in the thoracic cavity in CAP, following echocardiographic measurements were made in the left and right decubitus positions: the angle between the ultrasound beam and the left ventricular posterior wall (Angle- PW) in end-diastole at the parasternal long axis, and the distance between the chest wall and the most distal part of the left ventricular posterior wall (Distance- PW) at the parasternal mid-ventricular short axis. Results Angle- PW in patients with CAP were significantly greater than in those with ASD (100.1±12.5° vs 74.5±8.6°, p<0.017) or in normal subjects (100.1±12.5° vs 69.9±7.6°, p<0.017) at the left decubitus, and the difference in Angle- PW according to posture (left vs right) was significantly greater in CAP compared with the other groups (CAP 20.7±12.7°, ASD 0.31±1.80°, normal 0.31±1.40°, all p<0.017). The differences in Distance- PW according to patient position (CAP 2.43±0.77°, ASD 0.42±0.45°, normal 0.26±0.55°) or cardiac cycle in each position (left: CAP 1.60±0.76°, ASD 0.41±0.27°, normal 0.17±0.12°; right: CAP 0.70±0.32°, ASD 0.22±0.19°, normal 0.22±0.13°) were significantly higher in the CAP group than in the other groups (all p<0.017). Conclusions Patients with CAP have dynamic alteration in cardiac position depending on posture, which is not observed in ASD or in normal controls. Hence, total or left-sided CAP can be reliably diagnosed with positional changes during routine echocardiography.

AB - Objectives Congenital absence of the pericardium (CAP) is often confused with other conditions presenting with right ventricular dilatation and usually warrants CT or cardiac MR (CMR) to confirm. It would be desirable to have more specific echocardiographic criteria to provide a conclusive diagnosis. Methods 11 patients who were diagnosed with CAP (four patients with total CAP) based on CT/CMR were consecutively enrolled. Thirteen patients with atrial septal defect (ASD) and 16 normal subjects served as controls. To investigate spatial changes of heart in the thoracic cavity in CAP, following echocardiographic measurements were made in the left and right decubitus positions: the angle between the ultrasound beam and the left ventricular posterior wall (Angle- PW) in end-diastole at the parasternal long axis, and the distance between the chest wall and the most distal part of the left ventricular posterior wall (Distance- PW) at the parasternal mid-ventricular short axis. Results Angle- PW in patients with CAP were significantly greater than in those with ASD (100.1±12.5° vs 74.5±8.6°, p<0.017) or in normal subjects (100.1±12.5° vs 69.9±7.6°, p<0.017) at the left decubitus, and the difference in Angle- PW according to posture (left vs right) was significantly greater in CAP compared with the other groups (CAP 20.7±12.7°, ASD 0.31±1.80°, normal 0.31±1.40°, all p<0.017). The differences in Distance- PW according to patient position (CAP 2.43±0.77°, ASD 0.42±0.45°, normal 0.26±0.55°) or cardiac cycle in each position (left: CAP 1.60±0.76°, ASD 0.41±0.27°, normal 0.17±0.12°; right: CAP 0.70±0.32°, ASD 0.22±0.19°, normal 0.22±0.13°) were significantly higher in the CAP group than in the other groups (all p<0.017). Conclusions Patients with CAP have dynamic alteration in cardiac position depending on posture, which is not observed in ASD or in normal controls. Hence, total or left-sided CAP can be reliably diagnosed with positional changes during routine echocardiography.

KW - congenital pericardial absence

KW - echocardiography

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