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- Received March 21, 2011
- Accepted March 30, 2011
- Published online January 10, 2012.
A 47-year-old man presented with dyspnea and anasarca, and was found to have jugular venous distension, pleural effusions, and ascites. Three years earlier, he had undergone surgery and radiotherapy for esophageal cancer. Computed tomography revealed pericardial thickening (A). Echocardiography revealed a septal bounce (Online Video 1), plethoric inferior vena cava, dynamic variation in hepatic vein (B) and transmitral flow velocities and prominent mid-diastolic flow or L-wave during expiration (C). Radical pericardiectomy was performed for relief of constrictive pericarditis. Post-operatively, respirophasic Doppler variation was not observed (D).
Mid-diastolic flow, a marker of elevated left ventricular filling pressure, has been documented in constrictive pericarditis using velocity-encoded magnetic resonance imaging (1). In constrictive pericarditis, left atrial pressure increases in tandem with pulmonary venous return during expiration. The phasic variation of mid-diastolic flow provides elegant support for its pre-load dependency. EXP = expiration; INS = inspiratory phase.
- Received March 21, 2011.
- Accepted March 30, 2011.
- American College of Cardiology Foundation