Constrictive Pericarditis Impressing and Narrowing the Ascending Aorta

Abstract

A 77-year-old male patient was admitted to our institution with 1-year history of progressive dyspnea on exertion, and lower extremity edema. His chest x-ray showed a circumferential pericardial calcification and right-sided pleural effusion. The electrocardiography revealed atrial fibrillation with low voltage in all derivations and diffuse nonspecific T-wave inversions. The transesophageal echocardiography showed a thickened pericardium with biatrial enlargement and normal right and left ventricular systolic functions. A thick echogenic structure that caused impression and narrowing of the ascending aorta was observed. Simultaneous right and left heart catheterization showed elevation and equalization of right-sided and left-sided diastolic filling pressures, with characteristic dip and plateau. Aortic angiogram showed the ascending aorta was impressed and narrowed by calcified pericardium. Cine magnetic resonance imaging showed pericardial calcifications impressing and narrowing of the ascending aorta. All these findings were consistent with constrictive pericarditis. The patient had no history of tuberculosis, cardiac surgery, or mediastinal irradiation. His HIV antibody test was negative. Marked pericardial thickening and calcifications were evident during pericardiectomy. Histological analysis of the pericardium showed dense collageneous matrix, mild chronic inflammation and calcification. The culture of pericardial tissue revealed no identifiable cause including tuberculosis. The patient was diagnosed as idiopathic constrictive pericarditis. The patient's symptoms and edema decreased remarkably after pericardial stripping. He remained well at 1-year follow-up.

Constrictive pericarditis presenting with massive ascites without hemodynamic echocardiographic features

“…Although most pericardial constriction presents over the entire pericardium or over the right sided chambers, it may also present with atypical presentations when present focally over the pericardium, such as over the ascending aorta, pulmonary trunk, or the mid-ventricle. [9,10] This case suggests that the severity of the constriction as well as its symptomatology does not necessarily correlate to echocardiographic findings. It also underscores that importance of using imaging based on structural changes concomitantly with those that manifest the hemodynamic changes present with CP, and approaching suspected CP with a holistic approach; this includes usage of newer echocardiographic applications such as strain imaging, as well as CT, cardiac MRI, and cardiac catheterization.…”

Trapped heart in heavily calcified pericardium

“…Pericardiectomy is the only option to treat patients with symptoms of constrictive pericarditis which will result in improvement or normalization of the cardiac function in the majority of cases after releasing the restricted heart [ 5 ]. The aim of pericardiectomy procedure is to remove the calcified or fibrotic pericardium as much as possible [ 6 ]. The presence of calcified pericardium, which invades the myocardium, will increase the technical difficulty in removing the disease pericardium.…”