Constrictive Pericarditis Diagnosed by Cardiac Magnetic Resonance

Journal of the American College of Cardiology © 2010 by the American College of Cardiology Foundation Published by Elsevier Inc.

Vol. 56, No. 20, 2010 ISSN 0735-1097/$36.00 doi:10.1016/j.jacc.2010.04.062

IMAGES IN CARDIOLOGY

Constrictive Pericarditis Diagnosed by Cardiac Magnetic Resonance Jacob Lønborg, MD,*† Manu Mathur, MBBS,‡ Stuart M. Grieve, MBBS, DPHIL,*§ Ravinay Bhindi, MBBS, PHD,*储 Michael Ward, MBBS, PHD,*储 Harry Lowe, MBBS, PHD,¶ Jane McCrohon, MBBS, PHD,*# Gemma A. Figtree, MBBS, DPHIL*储 Sydney, Australia; and Copenhagen, Denmark

From the *North Shore Heart Research Group, Kolling Institute, University of Sydney, Sydney, Australia; †Department of Cardiology, Rigshospitalet, Copenhagen, Denmark; ‡Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia; §Department of Radiology, Royal Prince Alfred Hospital, Sydney, Australia; 储Department of Cardiology, Royal North Shore Hospital, Sydney, Australia; ¶Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia; and #St. Vincent’s Hospital, Sydney, Australia. Supported by North Shore Heart Research Foundation, and by the Sydney Medical Foundation, Sydney, Australia. Dr. Lønborg was supported by the Danish Heart Foundation and Rigshospitalet Research Foundation. Manuscript received April 12, 2010; revised manuscript received April 19, 2010, accepted April 21, 2010.

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he diagnosis of constrictive pericarditis is problematic, and management consequences are profound. A 68-year-old man was admitted with severe right-sided congestive heart failure 1 year after aortic valve replacement. Echocardiography showed normal biventricular systolic function and pulmonary artery pressures with modest respiratory variation in transmitral flow (A, Online Video 1). Computed tomography showed mild pericardial thickening with no calcification. Cardiac magnetic resonance imaging demonstrated thickening (B and C, arrows) and late gadolinium enhancement of the pericardium (D, arrow). Real-time images showed septal bowing toward the left ventricular cavity on inspiration (E and F, arrows, Online Video 2), consistent with ventricular interdependence, a hallmark of pericardial constriction. Tagged-cine imaging showed intact pericardial/epicardial gridlines during systole (G, Online Videos 3 and 4), consistent with concordant motion of the 2. Hemodynamic studies were supportive. Pericardectomy was performed, requiring 7 h of delicate stripping, and resulted in dramatic clinical improvement. Histology showed dense fibrosis (H). Cardiac magnetic resonance imaging is a key tool in the diagnosis of constrictive pericarditis.