Abstract 18735: Worsening Right Ventricular Structural Mechanics in Constrictive Pericarditis; Pericardiectomy Didn’t Fix the Problem!

Abstract

Introduction: Constrictive pericarditis (CP) is the result of scarring and consequent loss of the normal elasticity of the pericardial sac. Pericardiectomy is the definitive treatment for most cases of constriction. However it is believed structural changes in the right ventricle (RV) may result in tricuspid regurgitation (TR) after total pericardiectomy in patients with CP. Case report This is the case of a 55-year-old man who had a history of viral pericarditis, HTN and heart failure. He was evaluated for progressive pedal edema and ascites, found to have CP with equalization of RV and LV diastolic pressures and respiratory discordance of systolic pressures, consistent with CP on right heart catheterization. He underwent pericardiectomy and was found to have extensive pericardial adhesions and severe calcifications. Seven weeks later, he presented with complaints of fluid overload and was noted to have newly decreased RV systolic function accompanied by increase in RV volume with tricuspid annular dilation and 2-3+TR (Table and Figure). Diuretics were reinitiated and he is followed for potential tricuspid valve surgery. Discussion TR may develop post pericardiectomy in patients with CP. This is commonly noted with persistent RV failure symptoms post operatively. It may be caused by RV dilation and worsening TR, which results in increased RV strain, signifying poor status of longitudinal RV function. Tricuspid regurgitation is explained by RV and tricuspid annular dilatation. It is important to have a detailed evaluation perioperatively in patients with CP undergoing pericardiectomy.