Restrictive pericarditis

Background-Pericardial thickening is an uncommon complication of cardiac su rgery. Objectives-To study pericardial thickening as the cause of severe postopera tive venous congestion. Subjects-Two men, one with severe aortic stenosis and single coronary arter y disease, and one with coronary artery disease after an old inferior infar ction. Both had coronary artery bypass grafting surgery. Methods-Magnetic resonance imaging (MRI), Doppler echocardiography, and car diac catheterisation. Results-Venous pressure was raised in both patients. MRI showed mildly thic kened pericardium, and cardiac catheterisation indicated diastolic equalisa tion of pressures in the four chambers. Jugular venous pulse showed a domin ant "Y" descent coinciding with early diastolic flow in the superior vena c ava, and mitral and tricuspid Doppler forward flow proved restrictive physi ology. The clinical background suggested pericardial disease so both patien ts had pericardiectomy. This proved the pericardium to be thickened; the ex tent of fibrosis also involved the epicardium. Conclusions-Although rare, restrictive pericarditis (restrictive ventricula r physiology resulting from pericardial disease) should be considered to be a separate diagnostic entity because its pathological basis and treatment are different from intrinsic myocardial disease. This diagnosis may be conf irmed by standard investigational techniques or may require diagnostic thor acotomy.