Constrictive Pericarditis From a Severely Calcified Pericardium
A 42-year-old otherwise healthy woman presented with palpitations and gradual dyspnea on exertion. Her ECG showed normal sinus rhythm, an incomplete left bundle-branch block, and multiple premature atrial contractions. A posterior-anterior and lateral chest x-ray (Figure 1) demonstrated severe, dense calcification of the pericardium. The patient had been having palpitations for the past year and indolent dyspnea on exertion. She had a remote exposure to tuberculosis through her grandfather. The patient’s mother had constrictive pericarditis and underwent successful pericardial stripping many years ago. Purified protein derivative sensitivity testing was negative. Echocardiography, chest CT scan with cardiac CT angiography, and cardiac catheterization were performed. The pericardium was severely and diffusely calcified on CT scan (Figures 2 and 3⇓). Simultaneous right and left heart catheterization (Figure 4) showed elevation and equalization of diastolic pressures with characteristic dip and plateau. Left ventriculography (Movie; see Data Supplement) demonstrated abrupt diastolic relaxation. Cardiothoracic surgery was consulted and the patient underwent successful phrenic-to-phrenic nerve pericardial stripping (Figure 5). During her follow-up at 1 month, it was found that her dyspnea had been relieved and she was recovering without any difficulties.
These views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.
The Data Supplement, which contains a movie, is available at http://circ.ahajournals.org/cgi/content/full/112/11/e137/DC1.