Annular constrictive pericarditis. With an account of a patient with functional pulmonary, mitral, and aortic stenosis.

Five patients with constrictive pericarditis are described, in whom the main constriction was found at operation to be concentrated in an annular band forming a hoop around the pericardial sac, at the level of the atrio-ventricular grooves. In four of them, although the constriction was predominantly at this annulus, the effect on the heart was similar to that resulting from more generalized constriction. In the fifth, signs of functional pulmonary, mitral, and aortic stenosis developed seven years after the original operation for constrictive pericarditis, due to a double annular constriction, encircling the heart at the atrio-ventricular groove and also the root of the aorta and pulmonary artery. The five patients were under the care of Dr. William Evans and of Mr. Vernon Thompson, who operated upon them. Pre-operative investigation included postero-anterior and lateral radiograms, an electrocardiogram, and a phonocardiogram. In addition, cardiac catheterization was carried out before operation in two and in one it was repeated after operation.