Multimodal cardiac imagistic for constrictive pericarditis

Introduction: Constrictive pericarditis is a severely disabling consequence of the chronic inflammation of the pericardium, leading to an impaired filling of the ventricles. Etiology is most commonly idiopathic, but can be post inflammatory pericarditis, tuberculosis, after cardiac surgery and mediastinale iradiation. Today, the diagnosis of constrictive pericarditis often remains a challenge; all other causes of (right) heart failure and restrictive cardiomyopathy should be excluded. The treatment is pericardiectomy or heart transplant. Description of the pathoanatomical form is crucial for treatement, because the transient constrictive pericarditis is not indicated for pericardiectomy. Methods: Clinical and imagistical description of the case Results: Patient, 61 years old, with chronic idiopathic constrictive pericarditis. The discovery was accidental, the patient was sent for cardiac scanner before ablation of atrial fibrillation. Clinic: Signes of right heart failure. Cardiac scanner revealed extensive pericardial calcification with pericardial thickening, biatrial dilatation, the ventricles not dilatated and having a normal ejection function. Complementary, cardiac catheterization revealed appearance of “dip and plateau”. Cardiac MRI sho ws increased ventricular coupling with bouncing septum, with strong pericardium layers and without myo cardial layers after gadolinium administration. Sub total pericardectomie was made, postoperative echography revealed tricuspid pw Doppler without exagerate respiratory variations. Conclusions: Multimodal imaging approach, associated to clinical and laboratory data, provides descriptive and prognostic parameters for pericardectomy.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)