Constrictive pericarditis is an uncommon cause of heart failure. It is a clinical entity caused by thickening, fibrosis, and/or calcification of the pericardium. We present a 50-year-old female patient who was admitted to our institution with a 6-month history of progressive dyspnea on exertion, abdominal swelling, and lower extremity edema. Her chest X-ray revealed an oblique linear calcification in the cardiac silhouette. Transthoracic echocardiography revealed biatrial enlargement. Left ventricular size and systolic function were normal. Cardiac computed tomography revealed the pericardial thickening (>5？mm) and heavy calcification in left atrioventricular groove. Simultaneous right and left heart catheterization showed elevation and equalization of right-sided and left-sided diastolic filling pressures, with characteristic dip, and plateau. Pericardiectomy was performed which revealed a thick, fibrous, calcified, and densely adherent pericardium constricting the heart. The postoperative period was uneventful and was in NYHA functional class I after 3 months. 1. Introduction Constrictive pericarditis (CP) is uncommon cause of heart failure. It is a clinical entity caused by thickening, fibrosis, and/or calcification of the pericardium. This entity often leads to impairment of diastolic filling, resulting predominantly in symptoms of right heart failure [1]. Currently, idiopathic or viral pericarditis is the predominant cause in the industrialized countries, followed by cardiac surgery and mediastinal irradiation, which are as well the major and increasing causes of CP in the industrialized countries [2–4]. Tuberculosis is still a common cause of CP in developing and underdeveloped countries, as well as in the immunosuppressed patients [5]. Modern series from Saudi Arabia, Mexico, Turkey, and India document tuberculosis in 38% to 83% of all cases of CP. Pericardial disease rarely presents as the initial manifestation of tuberculosis [6–9]. Although pericardial calcification on chest X-ray suggests constriction, it is not diagnostic but may lead to more detailed investigations. A pericardial thickness less than 2？mm is normal and greater than 6？mm in size is specific for constriction [10]. Cardiac CT and MRI can detect pericardial thickening and calcification with high accuracy [11]. Echocardiography and new Doppler techniques are very useful for differential diagnosis between CP and restrictive cardiomyopathy [12, 13]. The gold standard for diagnosis is cardiac catheterization with analysis of intracavitary pressure curves, which are high in end
References
[1]
B. C. McCaughan, H. V. Schaff, and J. M. Piehler, “Early and late results of pericardiectomy for constrictive pericarditis,” Journal of Thoracic and Cardiovascular Surgery, vol. 89, no. 3, pp. 340–350, 1985.
[2]
L. H. Ling, J. K. Oh, H. V. Schaff et al., “Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardiectomy,” Circulation, vol. 100, no. 13, pp. 1380–1386, 1999.
[3]
J. Cameron, S. N. Oesterle, J. C. Baldwin, and E. W. Hancock, “The etiologic spectrum of constrictive pericarditis,” American Heart Journal, vol. 113, no. 2, pp. 354–360, 1987.
[4]
S. C. Bertog, S. K. Thambidorai, K. Parakh et al., “Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy,” Journal of the American College of Cardiology, vol. 43, no. 8, pp. 1445–1452, 2004.
[5]
P. P. Sengupta, M. F. Eleid, and B. K. Khandheria, “Constrictive pericarditis,” Circulation Journal, vol. 72, no. 10, pp. 1555–1562, 2008.
[6]
V. V. Bashi, S. John, E. Ravikumar, P. S. Jairaj, K. Shyamsunder, and S. Krishnaswami, “Early and late results of pericardiectomy in 118 cases of constrictuve pericarditis,” Thorax, vol. 43, no. 8, pp. 637–641, 1988.
[7]
M. Pedreira Pérez, A. Virgós Lamela, F. J. Crespo Mancebo, et al., “40 years’ experience in the surgical treatment of constrictive pericarditis,” Archivos del Instituto de Cardiologica de Mexico, vol. 57, pp. 363–373, 1987.
[8]
H. Raffa and J. Mosieri, “Constrictive pericarditis in Saudi Arabia,” East African Medical Journal, vol. 67, no. 9, pp. 609–613, 1990.
[9]
S. Arsan, S. Mercan, A. Sarigul et al., “Long-term experience with pericardiectomy: analysis of 105 consecutive patients,” Thoracic and Cardiovascular Surgeon, vol. 42, no. 6, pp. 340–344, 1994.
[10]
D. H. Spodick, The Pericardium: A Comprehensive Textbook, M. Dekker, New York, NY, USA, 1997.
[11]
R. Rienmuller, M. Gurgan, E. Erdmann, B. M. Kemkes, E. Kreutzer, and C. Weinhold, “CT and MR evaluation of pericardial constriction: a new diagnostic and therapeutic concept,” Journal of Thoracic Imaging, vol. 8, no. 2, pp. 108–121, 1993.
[12]
B. Maisch, P. M. Seferovi？, A. D. Risti？, et al., “Guidelines on the diagnosis and management of pericardial diseases. The Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology,” European Heart Journal, vol. 25, pp. 587–610, 2004.
[13]
J.-W. Ha, S. R. Ommen, A. J. Tajik et al., “Differentiation of constrictive pericarditis from restrictive cardiomyopathy using mitral annular velocity by tissue Doppler echocardiography,” American Journal of Cardiology, vol. 94, no. 3, pp. 316–319, 2004.
[14]
B. H. Lorell, “Pericardial diseases,” in Heart Disease, E. Braunwald, Ed., pp. 1496–1505, W.B. Saunders Company, Philadelphia, Pa, USA, 1997.
[15]
L. H. Ling, J. K. Oh, J. F. Breen et al., “Calcific constrictive pericarditis: is it still with us?” Annals of Internal Medicine, vol. 132, no. 6, pp. 444–450, 2000.
