CONSTRICTIVE PERICARDITIS AND ATRIAL SEPTAL DEFECT, SECUNDUM TYPE - WITH SPECIAL REFERENCE TO LEFT VENTRICULAR VOLUMES AND RELATED HEMODYNAMIC FINDINGS

1. 1. Two cases of secundum type atrial septal defect, complicated by constrictive pericarditis, in which the patients were surgically treated, are reported. 2. 2. The clinical features of atrial septal defect were preserved, but the degree of congestive heart failure in both and the age of onset of heart failure in the second patient were unusual. 3. 3. The clinical picture of constrictive pericarditis, particularly the severe, chronic right sided failure, was quite evident, but the characteristic Kussmaul sign and pulsus paradoxus were absent. 4. 4. The hemodynamic data represented a summation of both conditions. The oxygen saturation levels and equalization of atrial pressures were typical of atrial septal defect, whereas the pressure pulses were characteristic of constrictive pericarditis. 5. 5. The low resting systemic output and stroke volume were proved, by studies of left ventricular volume, to be due to a low enddiastolic volume and ejection fraction. This contrasts significantly with the increased enddiastolic volume seen in patients with myopathy. Marked reduction of ejection fraction, even with exercise, indicated impaired myocardial function. Postoperatively both the end-diastolic volume and ejection fraction rose to normal levels. 6. 6. Determination of ventricular volumes may offer a direct means of differentiating constrictive pericardial disease from primary myocardial disease. © 1969.