PMC8305648_01
Right-Sided Heart Catheterization Tracings. Elevated right atrial and pulmonary capillary wedge pressure with an early diastolic dip and plateau pattern in the right ventricular tracing. There is near equalization of the right ventricular end-diastolic, pulmonary capillary wedge, right atrial, and pulmonary artery diastolic pressures, thus raising suspicion of pericardial constriction or possibly restriction.
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Cardiac catheterization 2 weeks before admission (Figure 1) showed elevated right atrial (22 mm Hg) and pulmonary capillary wedge (26 mm Hg) pressures.
Transthoracic Echocardiogram. A large loculated pericardial effusion (Peri) causing compression of the left atrium (LA) and left ventricle (LV) as seen in the (A) parasternal long-axis view at end-diastole, (B) parasternal long-axis view at midsystole with mitral regurgitation, and (C) apical 4-chamber view at end-diastole. (D) The apical 3-chamber view demonstrates anterior displacement of the mitral apparatus with systolic anterior motion of the mitral valve (arrow). (E) There is a later peaking gradient of 18 mm Hg across the left ventricular outflow tract at rest and (F) a 9 mm Hg peak gradient by pulse-waved Doppler proximal to the left ventricular outflow tract. RA = right atrium; RV = right ventricle.
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There was at least mild to moderate mitral regurgitation with preserved biventricular systolic function (Figures 2A to 2F, Videos 1, 2, and 3).