Treatment of Tuberculous Constrictive Pericarditis with Pericardiectomy

A 77-year-old man from Ecuador presents with a 2-month history of progressive fatigue, exertional dyspnea, abdominal distention, and lower extremity edema.

His vital signs were pulse 74, respirations 14 per minute, and blood pressure 102/65 mmHg. Physical examination reveals jugular venous distension that increases with inspiration. The lungs were clear. The cardiac examination reveals soft S1 and S2 with S3 present. The abdomen is distended with a fluid wave. There is 3+ bilateral lower extremity edema to the waist. Laboratory values include CRP 1.8 mg/L and ESR 14 mm/hr. Interferon-gamma release assay for Mycobacterium tuberculosis is positive.

Representative subcostal view and tissue Doppler tracings from his echocardiogram are shown in Figures A and B respectively. Cross sectional imaging from cardiac magnetic resonance imaging (MRI) is shown in Figure C.

Figure A: Transthoracic Echocardiogram

Figure A

Figure B: Tissue Doppler tracings of mitral annulus, medial (left) and lateral (right)

Figure B

Figure C: Cardiac MRI

Figure C

Which of the following would be the most appropriate next step in treatment?

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