[Right heart failure following pericarditis constrictiva tuberculosa--urgent surgical treatment]

A 71-year-old male patient presented with a 4-month history of fever, dyspnoea, night sweat, ankle swelling and was admitted to our institution for further investigation due to heart failure (NHYA IV). A posterior-anterior chest radiograph showed an enlarged cardiac silhouette, the lung was without pathological findings; calcifications were not described. Echocardiography revealed a severe diastolic malfunction but no pericardial effusion. In computed tomography, pericardium was thickened. Patient was admitted for further investigations. Heart catheterization revealed a left ventricular ejection fraction of 56 %, a cardiac index of 1.3 ml/min/m2 leading to the diagnosis of severe constrictive pericarditis. The patient underwent an urgent pericardectomy via median sternotomy. Extracorporal circulation was not necessary. The postoperative course was uneventful, heart failure improved to NYHA II. The removed pericardium revealed severe granulomatous pericarditis resulting from infection with acid-resistant bacilli. The diagnosis was confirmed by a positive culture for mycobacterium tuberculosis. The patient was put on anti-TB chemotherapy for one year. 1 year after operation patient is graduated in NYHA class II.

This rare extrapulmonary form of TB can have an insidious or sudden onset. The diagnosis is complicated by non-specific clinical and radiographic findings. Clinical presentation may be the result of the infectious process itself or the pericardial inflammation causing pain, effusion, and hemodynamic effects. In the absence of concurrent extracardiac TB, diagnosis of pericardial TB is difficult. Nevertheless, rapid diagnosis and treatment are crucial to reduce mortality.