J Cardiovasc Ultrasound.  2009 Sep;17(3):102-105. 10.4250/jcu.2009.17.3.102.

Recurrent Postoperative Effusive-Constrictive Pericarditis Associated with Steroid Discontinuation

• Park GM
• Lee JY
• Kim YG
• Boo SJ
• Song JM
• Kang DH
• Song JK

• KMID: 1473735
• DOI: http://doi.org/10.4250/jcu.2009.17.3.102

Abstract

Transient effusive-constrictive pericarditis is a rare complication of open-heart surgery, but is increasingly recognized. For patients with both pericardial effusion and constrictive physiology soon after uneventful open-heart surgery, proper treatment remains to be established. We experienced a case of transient effusive-constrictive pericarditis in a 50-year-old woman who underwent aortic valve replacement due to infective endocarditis. Initially, she was treated with both prednisolone and ibuprofen, which resulted in dramatic relief of symptom. However, she suffered from a relapse of pericaridis after rapid steroid discontinuation and was stabilized by re-treatment with steroid.

Keyword

Postpericardiotomy syndrome; Constrictive pericarditis; Steroid

MeSH Terms

Aortic Valve
Endocarditis
Female
Humans
Ibuprofen
Middle Aged
Pericardial Effusion
Pericarditis
Pericarditis, Constrictive
Postpericardiotomy Syndrome
Prednisolone
Recurrence
Ibuprofen
Prednisolone

Figure

• 

  Fig. 1 A series of chest X-ray. Preoperative chest X-ray showed moderate cardiomegaly with increased pulmonary vascularity (A). Cardiomegaly and pulmonary congestion after operation was resolved (B). In 8 weeks after surgery, chest X-ray showed aggravated cardiomegaly compared with previous one (C). Under the diagnosis of postoperative effusive-constrictive pericarditis, patient was treated with prednisolone and ibuprofen for 7 weeks. Chest X-ray showed normalized heart size within 1 week (D) and after treatment (E). In 3 months after steroid discontinuation, chest X-ray revealed cardiomegaly again (F). The patient was suspected as recurrent effusive-constrictive pericarditis potentially associated with steroid discontinuation. Chest X-ray showed normalized heart size within 1 week (G) and in 6 months (H) after re-treatment with steroid.

• 

  Fig. 2 Representative echocardiograms. Preoperative transesophageal echocardiography showed multiple vegetations attached to aortic valve (A). After uneventful aortic valve replacement, moderate pericardial effusion (PE) with typical constrictive physiology developed (B and C), which resolved dramatically with medical treatment (D). After steroid discontinuation, pericardial effusion (E) and constrictive physiology redeveloped (F). Asterisk: vegetations.

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