Pericardial Adhesion Shown in Echocardiographic Subxiphoid View in a Patient With Postsurgical Pericardial Constriction
A 74-year-old woman who had undergone aortic valve replacement 3 years earlier was admitted to our hospital because of progressive right heart failure. Cardiac catheterization showed impaired diastolic filling (dip and plateau waveform) but lacked ventricular interdependence. Enlargement was marked in the right atrium and moderate in the left atrium (Figure 1A). Respiratory variation in transmitral Doppler E velocity was not significant (Figure 1B), but tricuspid E velocity during inspiration was increased by 31% over that measured during expiration (Figure 1C). Echocardiography in subxiphoid view revealed an unusual motion of the pericardium distinguished by a pulling on the liver (Figure 2). Subsequent thoracotomy revealed an area of thickened and adherent pericardium, chiefly around the anterior and diaphragmatic portions of the right ventricle (Figure 3). The physical signs of right heart failure abated after pericardiectomy, and the patient has continued to do well postoperatively.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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