PMC9112309_01
Transthoracic echocardiogram doppler imaging that shows the pathophysiology
during expiration that causes decreased right ventricular filling and
hepatic vein reversal during late diastole.
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In addition, it revealed several factors concerning for constrictive physiology including septal bounce, annulus reversus (mitral septal annular velocity = 0.16 m/s > mitral lateral annular velocity = 0.12 m/s), dilated, non-collapsible inferior vena cava, and biatrial enlargement with signs of ventricular interdependence and hepatic vein reversal (Figure 1).
Computed tomography (CT) of the heart revealed constrictive pericarditis with
thick circumferential pericardial calcifications and a loculated anterior
pericardial collection overlying and exerting mass effect on the right heart
chambers.
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Dedicated computed tomography (CT) heart imaging confirmed the diagnosis of constrictive pericarditis (Figure 2) and demonstrated a large loculated pericardial collection exerting mass effect on the right heart chambers.
PMC9112309_02
Simultaneous right and left heart catheterization showing ventricular
interdependence.
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The patient underwent cardiac catheterization, which demonstrated elevated left and right heart filling pressures, normal cardiac output and index, and simultaneous right and left ventricular pressures with interdependence, pressure equalization, and sharp y descents all consistent with constriction (Figure 3).