ostoperative constrictive pericarditis may not be as uncommon as we think. The incidence has been reported from 0.2% to 0.3% after open heart surgery 1-3 and should be suspected when the postoperative course deviates from expected. Although the actual cause is unknown, several factors after cardiac operations are suspected, including surgical trauma, hemopericardium, infection, postpericardiotomy inflammation, cold injury, and air desiccation. The onset has been reported from 2 weeks to 21 years after surgery 1,2 and we present an unusual case of a patient who developed symptoms of constrictive pericarditis 30 years after cardiac surgery. Case ReportA 54-year-old man was admitted for evaluation of exertional dyspnea and chest oppression. He had undergone closure of ASD via a median sternotomy 30 years previously and had not had any health problems since then. On admission, his blood pressure 94/66 mmHg and heart rate was 90 beats/min. The jugular vein was markedly distended and the liver was palpable below the right costal margin. Auscultation revealed no pathological sounds or arrhythmia. Laboratory data showed mild liver dysfunction (total billirubin of 1.9 mg/dl and lactate dehydrogenase of 567 IU/L). An electrocardiogram demonstrated normal sinus rhythm with inverted T waves in the precordal leads. The chest radiograph revealed mild cardiac enlargement with a cardiothoracic ratio of 0.6, right pleural effusion, calcification on the posterior and inferior parts of the cardiac silhouette, and 2 wires fixing the sternum. An echocardiography showed dilated right atrium (RA), ventricle (RV) and inferior vena cava (IVC), prominent diastolic flow reversals in the dilated hepatic vein (Fig 1), and an echolucent mass anterior to the main pulmonary artery (PA) and RV. On a computed tomography (CT) chest scan, the mass was revealed to be multiple cystic lesions compressing the PA and RV outflow (Fig 2). CT also showed right pleural effusion and a heavily calcified mass over the posterior and diaphragmatic sides of the heart. From the T2-weighted magnetic resonance imaging (MRI) scans, the cystic mass anterior to the PA seemed to contain blood, protein and viscous components (Fig 3). A gallium scintigram did not show accumulation of the agent around the heart. Cardiac catheterization revealed elevated end-diastolic pressures in the right atrium and both ventricles (22, 20, and 27 mmHg, respectively). The pressures were: RA 25/22 mmHg; RV 40/16 mmHg with an early diastolic dip; PA 41/23 mmHg; mean pulmonary wedge, 24 mmHg; and left ventricle, 119/14 mmHg. The thermodilution cardiac index was 2.8 L·min -1 ·m -2 .Circ J 2002; 66: 610 -612 (Received June 22, 2001; revised manuscript received July 18, 2001; accepted July 27, 2001 Constrictive Pericarditis Caused by Calcification and Organized Hematoma 30 Years After Cardiac SurgeryYoshiyuki Takami, MD; Hiroshi Ina, MD; Yukiaki Tanaka, MD*; Akihiro Terasawa, MD* A 54-year-old man, who had undergone atrial septal defect (ASD) closure 30 years previously, was admitted for exe...