title: A Potential Echocardiographic Classification for Constrictive Pericarditis Based on Analysis of Abnormal Septal Motion.
abstract: BACKGROUND
  Constrictive pericarditis is an uncommon condition that could be easily confused with congestive heart failure. In symptomatic patients, septal "wobble" on echocardiography may be an important sign of constrictive physiology. This study was planned to investigate the effects of constriction on septal motion as identified by echocardiography.
  
  
  METHODS
  In this retrospective observational study, nine consecutive patients with constriction underwent careful echocardiographic analysis of the interventricular septum (IVS) with slow motion 2-dimensional echocardiography and inspiratory manoeuvres. Six patients who had undergone cardiac magnetic resonance imaging underwent similar analysis. Findings were correlated with haemodynamic data in five patients who had undergone cardiac catheterisation studies.
  
  
  RESULTS
  In mild cases of constriction a single wobble of the IVS was seen during normal respiration. In more moderate cases a double motion of the septum (termed "double wobble") was seen where the septum bowed initially into the left ventricle (LV) cavity in diastole then relaxed to the middle only to deviate again into the LV cavity late in diastole after atrial contraction. In severe cases, the septum bowed into the LV cavity for the full duration of diastole (pan-diastolic motion). We describe how inspiration also helped to characterize the severity of constriction especially in mild to moderate cases.
  
  
  CONCLUSIONS
  Echocardiography appears a simple tool to help diagnose constriction and grade its severity. Larger studies are needed to confirm whether the type of wobble motions helps to grade the severity of constrictive pericarditis.
authors.affiliation: Department of Cardiology, Waikato Hospital, Hamilton, New Zealand.
authors.forename: Dilesh
authors.initials: D
authors.lastname: Jogia
authors.affiliation: Department of Cardiology, Waikato Hospital, Hamilton, New Zealand. ; Department of Cardiology, Khoo Teck Puat Hospital, Singapore.
authors.forename: Michael
authors.initials: M
authors.lastname: Liang
authors.affiliation: Department of Cardiothoracic Surgery, Waikato Hospital, Hamilton, New Zealand.
authors.forename: Zaw
authors.initials: Z
authors.lastname: Lin
authors.affiliation: Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: David S
authors.initials: DS
authors.lastname: Celemajer
keywords: Abnormal septal motion; Constriction; Constrictive pericarditis; Echocardiography; Heart failure; Magnetic resonance imaging