A Case of Effusive Constrictive Pericarditis
A 42-year-old male soldier in the Air National Guard presented to our hospital with a 2-month history of increasing dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and lower extremity edema, and presented to our hospital. Complete blood count, chemistries, liver-associated enzymes, and troponin were unremarkable. Electrocardiography showed only the presence of diffuse low voltages. Echocardiography revealed a large pericardial effusion with early tamponade, which was drained by pericardiocentesis. The patient returned 2 months later with worsening dyspnea, and a repeat echocardiogram revealed a moderate loculated pericardial effusion with a diastolic “bounce” of the ventricular septum (Data Supplement Movie I). A chest MRI revealed 6-mm pericardial thickening (Figure, B). He underwent cardiac catheterization, revealing diastolic equalization of left and right heart pressures and “dip-and-plateau” diastolic ventricular pressures supporting the diagnosis of effusive constrictive pericarditis (Figure, C). The patient underwent pericardial stripping starting with the left ventricular visceral pericardium, which resulted in marked immediate hemodynamic improvement (Data Supplement Movie II).
The online-only Data Supplement, which contains Movies I and II, is available at http://circ.ahajournals.org/cgi/content/full/112/10/e133/DC1.