A surgical case of solitary severe tricuspid regurgitation mimicking constrictive pericarditis

It has been reported that severe tricuspid regurgitation may demonstrate constrictive pericarditis-like hemodynamics. In this article, we report a surgical case of solitary severe tricuspid regurgitation in which the hemodynamic features are consistent with constrictive pericarditis.

The patient was a 78-year-old man with chronic atrial fibrillation and tricuspid regurgitation. He was admitted to our hospital with complaints of edema and dyspnea, and transthoracic echocardiography showed severe tricuspid regurgitation and enlargement of the bilateral atrium. A right heart catheterization revealed "dip and plateau" patterns in the biventricular pressure waveforms, and both right and left ventricle endo-diastolic pressure had increased to 30 mmHg. Although there were no signs of calcification or thickening of the pericardium in computed tomography, we diagnosed the patient with constrictive pericarditis with severe tricuspid regurgitation and underwent surgical intervention since his heart failure symptoms were resistant to medication. The surgical findings did not show any pericardial thickening or adhesions either; therefore, we diagnosed the patient with solitary severe tricuspid regurgitation showing constrictive pericarditis-like hemodynamics. We performed tricuspid valve replacement with a bioprosthetic valve and his heart failure symptoms improved postoperatively.

To determine the best timing for surgery, it is essential to recognize the existence of severe tricuspid regurgitation mimicking constrictive pericarditis.