Korean Circ J.  2011 May;41(5):283-286. 10.4070/kcj.2011.41.5.283.

Transient Right Ventricular Dysfunction After Pericardiectomy in Patients With Constrictive Pericarditis

• Yu HT
• Ha JW
• Lee S
• Shim CY
• Moon J
• Cho IJ
• Kang MK
• Yang WI
• Choi D
• Chung N

• KMID: 2297938
• DOI: http://doi.org/10.4070/kcj.2011.41.5.283

Abstract

Pericardiectomy is the standard treatment in patients with chronic constrictive pericarditis who have persistent symptoms. However, myocardial atrophy with prolonged pericardial constriction and abrupt increase in venous return can lead to heart failure with volume overload after pericardial decompression, especially in the right ventricle (RV). We experienced a 44 year old male patient who developed transient RV failure after pericardiectomy for constrictive pericarditis. Echocardiography revealed a markedly dilated RV with decreased peak systolic velocity of the tricuspid annulus, suggesting severe RV dysfunction. After treatment with inotropics and diuretics, a follow-up echocardiography revealed an improved systolic function with decreased RV chamber size. This case demonstrates the importance of volume overload and RV dysfunction in patients with constrictive pericarditis undergoing pericardiectomy.

Keyword

Right ventricular dysfunction; Constrictive pericarditis; Pericardiectomy

MeSH Terms

Atrophy
Constriction
Decompression
Diuretics
Echocardiography
Follow-Up Studies
Heart Failure
Heart Ventricles
Humans
Male
Pericardiectomy
Pericarditis, Constrictive
Ventricular Dysfunction, Right
Diuretics

Figure

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  Fig. 1 Left ventricular tissue Doppler image shows preserved early diastolic mitral annular velocity (E') on preoperative echocardiography (A), decreased E' on postoperative (B) and 7 months follow up echocardiography (C).

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  Fig. 2 Right ventricular tissue Doppler image shows normal tricuspid annular velocity (S') on preoperative echocardiography (A), reduced S' on postoperative echocardiography (B), and slightly increased S' on echocardiography of 7 months follow up (C).

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  Fig. 3 Two-dimensional echocardiography of the parasternal short-axis view (A, C and E) and apical 4-chamber view (B, D and F). The echocardiography showed pericardial thickening and relatively small sized RV (end-diastolic volume: 34.6 mL) at admission (A and B). Postoperative echocardiography revealed markedly dilated RV (end-diastolic volume: 85.6 mL) with D-shaped LV (C and D). The RV size was decreased (end-diastolic volume: 59.7 mL) on echocardiography after 7 months (E and F). RV: right ventricle, LV: left ventricle.

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