Annular constrictive pericarditis causing hour-glass contracture of the right ventricle

Abstract

Objectives: Constrictive pericarditis (CP) is characterized by the encasement of the heart by a rigid non-pliable pericardium due to dense fibrosis and adhesions. We hereby describe a rare case of annular constrictive pericarditis (ACP) causing localized constriction of right ventricle leading to its hour-glass contracture, which to our knowledge is the second case managed successfully for ACP. Case presentation: A 13-year old boy presented with complaints of dyspnea on exertion NYHA class III his daily activities. On examination, his respiratory rate was 28 cycles per minute, jugular venous pressure was raised by 15 cm from sternal angle and had a prominent y descent and with a positive Kussmaul’s sign. Hence, a clinical diagnosis of constrictive pericarditis was suspected. After routine blood investigations, chest X-ray, computed tomography (CT) scan and informed consent, total pericardiectomy was done. The gross and microscopic features were compatible with tuberculous pericarditis. Patient was discharged on post-operative day 5. Conclusions: ACP is a rare form of CP, which should always be suspected in patients presented with predominant right heart failure symptoms and total pericardiectomy should be performed at the earliest.

Keywords

• annular constrictive pericarditis
• median sternotomy
• off pump total pericardiectomy
• hour-glass contracture of right ventricle