Hemodynamics of Constrictive Pericarditis: A Case Report

Abstract

Abstract: To diagnose constrictive pericarditis requires a high degree of clinical acumen as the signs and symptoms overlap with other cardiac diseases. Usually as cardiologists, we encounter most of our disease burden labeled under ischemic and valvular heart disease and when encountered with constrictive pericarditis, an uncommon diagnosis, like this case report it can get overlooked. Early diagnosis can lead to definite treatment with surgical percardiectomy.  There is little room for medical therapy in constrictive pericarditis and in cases diagnosed too late, who develop advanced heart failure symptoms from it, don’t derive as much benefit from surgical percardiectomy. We are sharing this case report, where diagnosis of constrictive pericarditis was initially missed; and what work up we did for diagnosis with special focus on right heart catheterization with hemodynamics that we used to refer the patient for percardiectomy.

Materials and Methods : For the right heart catheterization, Right groin area was sterilized  with pyodine liquid and draped. The subcutaneous tissue was numbed with 10 ml of 2% lidocaine injection. The right femoral vein vascular access was taken via 6 Fr sheath. The Arrow® Double-Lumen Balloon Wedge-Pressure Catheter was used to obtain tracings of the right heart system. The right femoral artery access for taken via 5 Fr sheath. Pig tail catheter used to measure left ventricular pressures. This case has been reviewed and approved by the IRB (Institution review board) of Bahria International Hospital, Lahore. The literature for discussion was reviewed from Pub Med and internet search engines before submission.         

Results and Conclusions : The right heart catheterization revealed the equalization of high diastolic pressures in each chamber of the heart , including the characteristic sign of ventricular interdependence between the left and right ventricles. In conclusion, despite advancement of CT technology , right heart catheterization remains an integral part of constrictive pericarditis workup. Tracings for constrictive pericarditis hemodynamics can be found be found in cardiology text books but it is emphasized that the reason for submission of the case report is that the right heart catheterization is not routinely done in most major cardiac centers in Pakistan and important serious diseases such as the aforementioned can be easily missed by not regularly performing this procedure.