The Angiographic Appearance of the Coronary Arteries in Constrictive Pericarditis

Coronary artery motion was evaluated in normal subjects and patients with constrictive pericarditis (CP), congestive cardiomyopathy, restrictive cardiomyopathy, and coronary artery disease. Seven of the 8 patients with CP had lack of motion of the major coronary arteries. Nine of the 10 patients with congestive cardiomyopathy and a markedly reduced ejection fraction showed normal motion, as did all 4 with restrictive cardiomyopathy and 9 of the 10 with segmental dysfunction due to coronary disease. Pericardial stripping in 5 patients with CP revealed epicardial involvement corresponding to regions of absent motion; one CP patient with normal motion had no epicardial involvement. Lack of motion may suggest CP when the diagnosis is unsuspected, right heart pressures are not obtained, or hemodynamics are atypical. This sign may also help to distinguish CP from restrictive cardiomyopathy, which produces similar hemodynamics.