Abstract 14911: Effusive Constrictive Pericarditis: A Rare Complication of SARS-CoV-2 Infection

Abstract

Background: SARS-CoV-2 infection can result in cardiac complications, including myocarditis, left ventricular dysfunction, arrhythmias, and acute myocardial injury. Reports of effusive constrictive pericarditis (CP) are rare, and recommendations on management are limited. Description of Case: A 30-year-old male with recurrent episodes of effusive pericarditis after SARS-CoV-2 infection 11 months prior and anasarca presents with worsening fatigue, dyspnea, and weight gain. His echocardiogram showed pericardial thickening, annulus reversus, and interventricular septal bounce. Computed tomography showed pericardial thickening and a complex pericardial effusion. Right and left heart catheterization revealed elevated filling pressures, equalization of diastolic pressures, and ventricular discordance (Figure 1). Infection, malignancy, and autoimmune etiologies of CP were ruled out. Decision Making: The patient was initiated on anti-inflammatory therapy and aggressively diuresed with no improvement in his symptoms. Given recurrent episodes of pericarditis with constriction, the patient underwent a radical pericardiectomy with posterior pericardial release. The pericardium was 1 cm thick with severe fibrosis. Surgical pathology showed acute and chronic pericarditis with negative testing for Mycobacterium tuberculosis. Conclusion: Idiopathic, post-cardiac surgery and post-mediastinal radiation are the most common causes of CP. Acute pericarditis is a known complication of SARS-CoV-2 infection, but ongoing inflammation leading to CP is rare. CP presents with signs of heart failure and should be considered in patients with persistent symptoms of pericarditis.