Massive and Severe Calcific Constrictive Pericarditis

Abstract

41-year-old Nigerian woman was admitted to ourhospital complaining weakness, fatigue, chest pain,palpitations, gradual dyspnea on exertion, ascites, andpedal edema. There was no history of fever or cough.Routine blood examination results were normal, and atuberculin test result was negative. The physical exami-nation revealed peripheral edema, hepatomegaly, as-cites, and neck veins that were grossly distended. Thecardiac examination showed a normal heart size andvague distant heart sounds with a distinct pericardialknock. An electrocardiogram showed a normal sinusrhythm with a heart rate of 95 beats/min and an incom-plete left bundle branch block. A chest radiograph re-vealed diffuse and dense calcification of the pericardium(Fig 1A, arrows). A thoracic computed tomographic (CT)scan demonstrated a calcific pericardium surroundingthe entire heart (Fig 1B, arrow; Fig 1C, CT volumerendering showing calcific pericardium, arrow). Two-dimensional echocardiography confirmed severe peri-cardial calcification and revealed poor left ventricularejection fraction with pulmonary hypertension. Catheter-ization demonstrated rapid filling and elevation andequalization of left and right ventricular and diastolicpressures at a value of 18 mmHg. She underwent, viamedian sternotomy without cardiopulmonary bypass,pericardial resection with electrocauterization at 60 mVto avoid causing diathermal dysfunction of the rightventricle. Histologic examination showed fibrosis, mildchronic inflammation, and calcification. During the firstpostoperative month, the functional capacity of the pa-tient improved remarkably. Constrictive pericarditis, anuncommon entity, is characterized by an inflammatoryprocess that leads to progressive pericardial fibrosisencasing the heart in a thickened and fibrotic pericar-dium. The most common etiology in developing coun-tries is tuberculosis, but in industrialized nations theetiology is unclear in many cases (idiopathic constrictivepericarditis); the three most common identifiable causesare cardiac surgery, pericarditis, and mediastinal irradi-ation. Other possible causes include connective tissuediseases, malignancy, trauma and infections [1]. Todaypericardiectomy is generally a safe procedure, althoughthe early postoperative death risk is more than 2%.Survival rates vary from 55% to 90% on the basis of age,sex, and race [2].