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Persistence of constrictive pattern despite improvement in symptoms after the waffle procedure: A case report of

Tadanori Minagawa1, Takahiro Ohara2, Kaoru Hasegawa3

  • 1Division of Cardiovascular Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan.

Journal of Cardiology Cases
|August 11, 2020
PubMed

Insights

Constrictive pericarditis (CP) treatment can improve heart failure symptoms even if hemodynamic patterns persist post-surgery. Reduced intraoperative right atrial pressure predicts better outcomes in CP patients.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Pericardial Diseases

Background:

  • Constrictive pericarditis (CP) is a rare condition causing right-sided heart failure due to reduced pericardial compliance.
  • Pericardiectomy is the standard surgical treatment for CP, aiming to restore normal cardiac hemodynamics.
  • Some patients experience persistent hemodynamic abnormalities despite clinical improvement after pericardiectomy.

Observation:

  • This case report details a 61-year-old male diagnosed with CP presenting with shortness of breath and edema.
  • The patient underwent a pericardiectomy using an ultrasonic scalpel (waffle procedure).
  • Post-operative assessment revealed persistent dip-and-plateau pressure patterns but improved right ventricular (RV) and left ventricular (LV) end-diastolic pressures.

Findings:

  • Post-operative Doppler echocardiography showed improved respiratory variation in mitral and tricuspid inflow velocities.
  • A decrease in intraoperative right atrial pressure was observed.
  • Reduced respiratory variability in LV and RV inflow on echocardiography correlated with improved heart failure symptoms.

Implications:

  • Intraoperative right atrial pressure and post-operative echocardiographic findings are key predictors of heart failure symptom improvement in CP.
  • These hemodynamic markers are valuable even when characteristic constrictive patterns like the dip-and-plateau remain.
  • This highlights the importance of comprehensive post-operative assessment in managing constrictive pericarditis.

Keywords:
Constrictive pericarditisDip and plateauWaffle procedure

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