BackgroundConstrictive pericarditis is a rare condition which is characterized by pericardial layers thickening and it may not be relieved by conventional medical or surgical therapies. Some patients could profit from specific surgical techniques such as the waffle procedure which removes epicardial tissue strips of the visceral layer of the pericardium. It alleviates diastolic dysfunction, since it is known that the constrictive physiology observed in constrictive pericarditis depends mainly on the visceral layer.Case summaryWe describe the case of a 59-year-old male complaining of predominantly right heart failure symptoms. Initially, a transthoracic echocardiogram showed pericardial effusion with several fibrous tracts and a constrictive pattern. The work-up was completed with thoracic computed tomography and right heart catheterization along with several microbiological, serological and immunological tests. The final diagnosis was idiopathic constrictive pericarditis. The clinical course was unfavourable, and the patient was referred for prompt surgical treatment using a technique called the waffle procedure. Subsequently, the patient has remained asymptomatic.DiscussionConstrictive pericarditis combines features of both constriction and tamponade. Some patients may present an unfavourable clinical course with conventional therapeutic approaches. They could benefit from the waffle procedure which allows an improvement in diastolic and, subsequently, in systolic function.

La inflamación del miocardio, vírica o no, recibe el nombre de miocarditis. Este cuadro supone un reto para el médico clínico en su práctica habitual, ya que es fundamental realizar un diagnóstico diferencial correcto con otros cuadros que puede emular. La biopsia endomiocárdica ha sido clásicamente la técnica de referencia en el diagnóstico de esta entidad, aunque actualmente la cardio-RM es la técnica más empleada para valorar este tipo de pacientes. Se presenta un caso de un paciente con miocarditis aguda con el que se pretende enfatizar el papel protagonista de la cardio-RM como prueba de imagen de elección.