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Severe tricuspid regurgitation mimicking constrictive pericarditis
Ebru Ozpelit1, Bahri Akdeniz1, Mehmet Emre Ozpelit2
1Department of Cardiology, Dokuz Eylul University, School of Medicine, Izmir, Turkey.
The American Journal of Case Reports
|July 5, 2014
Summary
Severe tricuspid regurgitation can mimic constrictive pericarditis, presenting a diagnostic challenge. This case highlights how enlarged right heart chambers due to severe TR can restrict the intact pericardium, mimicking constrictive physiology.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Cardiac Physiology
Background:
- Tricuspid regurgitation (TR) can present hemodynamic findings similar to constrictive pericarditis (CP).
- This similarity arises from the enlarged right heart in severe TR restraining the intact pericardium and left ventricle.
Purpose of the Study:
- To report a challenging case of severe tricuspid regurgitation mimicking constrictive pericarditis.
- To illustrate the diagnostic difficulties and underlying mechanisms when TR presents with constrictive physiology.
Main Methods:
- A 62-year-old woman with exertional dyspnea, fatigue, and leg edema presented with symptoms of right heart failure.
- Echocardiography revealed enlarged right heart chambers and severe TR; right heart catheterization showed constrictive physiology.
- Noninvasive imaging (echocardiography, CT, MRI) did not reveal pericardial pathology, leading to further investigation of the TR as the cause of the observed hemodynamics.
Main Results:
- Right heart catheterization demonstrated elevated and equalized diastolic pressures in both ventricles, with a characteristic deep and plateau pattern.
- Despite extensive noninvasive imaging, no evidence of constrictive pericarditis was found.
- Surgical inspection confirmed a normal pericardium and a severely dilated tricuspid annulus.
Conclusions:
- Severe tricuspid regurgitation can present with hemodynamic findings indistinguishable from constrictive pericarditis.
- The enlarged right heart in severe TR can cause external compression on the intact pericardium and left ventricle, mimicking constrictive physiology.
- Absence of significant respiratory variations in hemodynamic parameters on advanced imaging suggests a normal pericardium, aiding in differential diagnosis.
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