Constrictive Pericarditis Following Heart Transplant

A 60-year-old woman presents with exertional shortness of breath, abdominal distention, lower extremity edema and weight gain. She had a heart transplant 14 years prior for familial hypertrophic cardiomyopathy. Over the last few years she has experienced recurrent episodes of volume overload which have been treated with diuretics by her local doctor. Otherwise, she has had an unremarkable post-transplant course, including no history of rejection on surveillance endomyocardial biopsies. Home medications include tacrolimus, mycophenolate mofetil, rosuvastatin, aspirin, lisinopril, and furosemide. Physical exam is notable for jugular venous distention to the angle of the jaw when the patient is upright at 90 degrees with a rapid y descent, distended abdomen with fluid wave, and 3+ pitting lower extremity edema to the mid-thigh. Selected clips from a transthoracic echocardiogram (TTE) and cardiac magnetic resonance imaging (MRI) are displayed in Videos 1-5.

Cardiac catheterization demonstrates the following measurements with select hemodynamic tracings shown in Figures 1 and 2.
RA = 23 mmHg
RV = 42/23 mmHg
PA = 32/23 mmHg, mean = 30 mmHg
PCWP = 23 mmHg
LV = 120/23 mmHg
Cardiac output = 7.85 L/min

The patient is diagnosed with constrictive pericarditis and referred for further management.

Video 1

Video 1: TTE, parasternal long axis view demonstrating dilated left atrium and pericardial thickening of the posterior wall

Video 2

Video 2: TTE, parasternal short axis view demonstrating leftward shift of the interventricular septum during inspiration

Video 3

Video 3: TTE, apical four chamber view demonstrating ventricular septal bounce and conical compression of the right ventricle

Video 4

Video 4: Cardiac MRI demonstrating restricted right ventricular movement and diastolic septal bounce

Video 5

Video 5: Cardiac MRI demonstrating respirophasic shift with ventricular interdependence

Figure 1

Figure 1
Figure 1: Right atrial waveform demonstrating prominent Y descent

Figure 2

Figure 2
Figure 2: Right ventricular waveform demonstrating a diastolic dip and plateau tracing, also called the "square root" sign

Which of the following statements is true regarding surgical pericardiectomy for constrictive pericarditis?

Show Answer