Constrictive Pericarditis: a major diagnostic challenge

• Type: Summary of Presentation in an International Conference
• Date: 2012

Authors

Rangel I (Author) Other; Sousa C (Author) Other; Lopes R (Author) Other; Oliveira S (Author) Other; Lebreiro A (Author) Other; Sousa A (Author) Other; Correia AS (Author) Other; Paiva M (Author) Other; Ribeiro V (Author) Other; Melão F (Author) Other; Almeida PB (Author) Other; Maciel MJ (Author) FMUP

Conference proceedings International

Title: European Journal of Heart Failure Supplements

Initial page: P1012

Heart Failure Congress 2012

Belgrade, 2012

Scientific classification

FOS: Medical and Health sciences > Clinical medicine

Other information

Abstract (EN): oduction: Constrictive pericarditis is a rare entity, representing a major diagnostic challenge. Clinical case: We describe a case of a 56 year-old man with a history of myocardial infarction (1999), having evolved with severe dilation of the left ventricle (LV), apical aneurysm, severe LV systolic dysfunction (LVSD) and mitral regurgitation (MR) due to posterior mitral leaflet prolapse. In 2004, he was submitted to a conservative mitral valve surgery, having evolved with LV slight dilation, moderate LVSD and slight MR. Three years after surgery (2007), started progressive heart failure aggravation, showing signs of peripheral congestion, without pulmonary congestion. The electrocardiogram showed atrial fibrillation and left bundle branch block. The echocardiogram reevaluation showed severe LV dilatation with severe LVSD; mitral annulus normally inserted, with mild MR, and revealed a restrictive transmitral flow pattern. There was also moderate tricuspid insufficiency, with gradually worsening, signs of pulmonary hypertension and slight compromise of right ventricular function. The chest radiograph revealed signs of apical pericardial calcification. Although treatment optimization, there was progressive worsening of clinical status. So, the patient was admitted to the Cardiology Department for clinical stabilization. Given the lack of therapy response, the patient was proposed for heart transplantation. For complementary evaluation, the patient performed cardiac catheterization that showed moderate coronary artery disease, pericardial calcification in the anterolateral and apical segments and equalization of end-diastolic pressures of cardiac chambers, showing the typical "dip and plateau" pattern at the both ventricles pressure curves. Given these data, the diagnosis of constrictive pericarditis was made, and its etiology was attributed to postpericardiotomy pericarditis, following surgery made four years ago. Pericardiectomy was considered a high risk intervention to this patient, so pre-heart transplant evaluation has been advanced. In November 2008, the patient got his heart transplant, without complications. The pre-discharge ETT showed preserved biventricular systolic function, and since then, the patient evolved favorably and is currently asymptomatic. Conclusion: This case shows the importance of high clinical suspicion for the diagnosis of constrictive pericarditis, an entity potentially treatable when recognized in time.

Language: English

Type (Professor's evaluation): Scientific

Notes: Rangel I, Sousa C, Lopes R, Oliveira S, Lebreiro A, Sousa A, Correia AS, Paiva M, Ribeiro V, Melão F, Almeida PB, Maciel MJ. Constrictive Pericarditis: a major diagnostic challenge. Eur J Heart Fail Suppl 2012; 11(Suppl 1): P1012. ISSN 1567-4215. Heart Failure Congress 2012, Belgrade, 2012