Pericardial constriction as a late complication of coronary bypass surgery

A 55-year-old man had progressive dyspnea, recurrent atrial arrhythmias, and severe right heart failure following coronary bypass surgery. His condition improved only slightly with the usual decongestive therapy. When transferred for further studies 5 months after the operation, he had typical clinical and hemodynamic findings of constrictive pericarditis. Review of chest films following the bypass operation revealed a large pericardial effusion or hematoma, the incomplete resolution of which probably caused the pericardial constriction confirmed at thoracotomy. The man was treated by pericardiectomy. A recent report on the incidence of overt tamponade soon after bypass surgery suggests that a significant volume of pericardial fluid accumulates in the early postoperative course in many instances and that late constriction may not be a rare complication. In treating patients who have circulatory congestion after such operations, it is important that the physician consider constrictive pericarditis and not assume that the clinical findings are the consquence of myocardial failure.