Author + information
- Received April 12, 2010
- Revision received April 19, 2010
- Accepted April 21, 2010
- Published online November 9, 2010.
- Jacob Lønborg, MD*,†,
- Manu Mathur, MBBS‡,
- Stuart M. Grieve, MBBS, DPhil*,§,
- Ravinay Bhindi, MBBS, PhD*,∥,
- Michael Ward, MBBS, PhD*,∥,
- Harry Lowe, MBBS, PhD¶,
- Jane McCrohon, MBBS, PhD*,# and
- Gemma A. Figtree, MBBS, DPhil*,∥
The diagnosis of constrictive pericarditis is problematic, and management consequences are profound. A 68-year-old man was admitted with severe right-sided congestive heart failure 1 year after aortic valve replacement. Echocardiography showed normal biventricular systolic function and pulmonary artery pressures with modest respiratory variation in transmitral flow (A, Online Video 1). Computed tomography showed mild pericardial thickening with no calcification. Cardiac magnetic resonance imaging demonstrated thickening (B and C, arrows)and late gadolinium enhancement of the pericardium (D, arrow). Real-time images showed septal bowing toward the left ventricular cavity on inspiration (E and F, arrows, Online Video 2), consistent with ventricular interdependence, a hallmark of pericardial constriction. Tagged-cine imaging showed intact pericardial/epicardial gridlines during systole (G, Online Videos 3and 4), consistent with concordant motion of the 2. Hemodynamic studies were supportive. Pericardectomy was performed, requiring 7 h of delicate stripping, and resulted in dramatic clinical improvement. Histology showed dense fibrosis (H). Cardiac magnetic resonance imaging is a key tool in the diagnosis of constrictive pericarditis.
Supported by North Shore Heart Research Foundation, and by the Sydney Medical Foundation, Sydney, Australia. Dr. Lønborg was supported by the Danish Heart Foundationand Rigshospitalet Research Foundation.
- Received April 12, 2010.
- Revision received April 19, 2010.
- Accepted April 21, 2010.
- American College of Cardiology Foundation