PMC9290158_01
Echocardiogram (A) parasternal long axis, (B) parasternal short axis, and (C) apical 4 chamber. Moderate pericardial effusion (arrows) and moderately dilated right atrium and left atrium.
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An echocardiogram showed moderate pericardial effusion, dilated right and left atria (Figure 1), and severe tricuspid regurgitation with a right ventricular systolic pressure of 41 mm Hg.
Anatomic pathology after pericardial window. Pericardial tissue with reactive mesothelial cells (arrows) at (A) 10x and (B) 20x.
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The anatomic pathologic results on the pericardial tissue sample showed only reactive mesothelial changes (Figure 2).
Cardiac magnetic resonance imaging (CMR) showing pericardial effusion (A-C). Bilateral pleural effusion (A, B). Small ascites (A). Ventricular septum flattening during inspiration (C).
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Cardiac magnetic resonance (CMR) imaging showed moderate pericardial effusion with flattening of the interventricular septum during inspiration, small bilateral pleural effusion, ascites, and normal myocardium (Figure 3).
(A) Right atrial pressure tracing showing prominent Y descent (arrows). (B) Equalization of biventricular end-diastolic pressures (circle) with pronounced right ventricular rapid filling wave >7 mm Hg.. Abbreviations: LV, left ventricle; RV, right ventricle.
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The pressure waveform showed prominent Y descent with pronounced right ventricular rapid filling wave the "square root sign" (Figure 4).
Studies post fistula closure. Left and right heart cardiac catheterization (A and B) showing (A) normal right atrial pressures, prominent Y descent no longer present. (B) There is no equalization of end-diastolic pressures or pronounced right ventricular rapid filling wave. Follow-up echocardiogram 1 month after AV fistula closure (C and D) showing only mild pericardial effusion (arrow).. Abbreviations: LV, left ventricle; RV, right ventricle.
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An echocardiogram showed a small amount of pericardial effusion and mild tricuspid regurgitation. A repeat cardiac catheterization revealed resolution of the constrictive physiology with normalization of right and left heart hemodynamics (Figure 5; Table 1).