Constrictive Pericarditis as a Post-Cardiac Surgery Complication.

Abstract

BACKGROUND Constrictive pericarditis is a chronic inflammatory process characterized by fibrosis and impaired ventricular filling. The diagnosis is challenging because of overlapping clinical features with other pathologies such as cardiac tamponade, and restrictive cardiomyopathy. We report a case of effusive-constrictive pericarditis with cardiac tamponade in a patient with a history of multiple myeloma, bone marrow transplantation, and colchicine treatment. CASE REPORT A 62-year-old woman was admitted to a hospital in Germany due to cardiac tamponade secondary to bacterial pericardial effusion that necessitated emergency sternotomy and pericardial washout. After a prolonged and complicated hospital course, she flew back to Orlando and presented on her day of arrival because of progressive dyspnea. A computed tomographic angiogram of the chest ruled out pulmonary embolism but showed a moderate pericardial effusion with a mass effect on the right ventricle showing a recurrent cardiac tamponade. Echocardiography suggested the diagnosis of constrictive pericarditis. Cardiac catheterization showed a mean right atrial pressure of 25 mmHg and a simultaneous left and right ventricular pressure waveform of ventricular interdependence, diagnostic of effusive-constrictive pericarditis. Colchicine, along with heart failure core measures, were started and resulted in symptomatic improvement. Her first pericardial effusion was bacterial, while the second was possibly a consequence of the cardiac surgery. CONCLUSIONS Cardiac catheterization has been the criterion standard for diagnosis of constrictive pericarditis. Colchicine may be curative for individuals exhibiting subacute symptoms. This case highlights the presentation and diagnosis of effusive-constrictive pericarditis, which can be associated with cardiac tamponade.