A case of effusive-constrictive pericarditis after cardiac surgery

A 60-year-old woman who had undergone repair of an atrial septal defect was readmitted to the hospital with dyspnea, abdominal distention, and leg ede ma 31 months after surgery. An echocardiogram demonstrated massive pericard ial effusion. Cardiac catheterization revealed elevation and equilibrium of the 4-chamber diastolic pressure and a dip and-plateau pattern in the righ t and the left ventricular pressures. Despite removal of pericardial fluid by pericardiocentesis, the findings and symptoms did not improve. The patie nt underwent both parietal and visceral pericardiectomy after which strikin g hemodynamic and symptomatic improvement occurred. Effusive-constrictive p ericarditis is uncommon but should be considered in patients with refractor y heart failure and massive pericardial effusion showing no improvement aft er removal of pericardial fluid.