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 B: Tissue Doppler tracings of mitral annulus, medial (left) and lateral (right)
Figure C: Cardiac MRI
Which of the following would be the most appropriate next step in treatment?