Constrictive Pericarditis with a Calcific Mass Invading into the Right Ventricular Myocardium

Abstract

We present a rare and unique case of calcific constrictive pericarditis with a calcified pericardial mass invading the right ventricular myocardium. Perioperative two-dimensional and three-dimensional transesophageal echocardiography revealed the extent and structure of the pericardial mass and led to the repair of the right ventricular free wall as a surgical intervention.

Pericardial constriction with calcified cystic mass compressing the right ventricle and right coronary artery

“…Calcific constrictive pericarditis is an uncommon disorder, characterized by fibrosis and calcification of the pericardium that progressively impair the diastolic filling of the heart, causing symptoms of heart failure [1] . Pericardial constriction may be localized, leading to focal compression of the right or left ventricle and rarely coronary obstruction [2][3][4][5] . Fluid collections may develop between calcified visceral and parietal layers of the pericard, causing pericardial cysts or localized pericardial mass.…”

“…Although several cases of right ventricular compression by constrictive pericardium were reported in the literature [3][4][5][6] , the combination of both right ventricular free wall compression and epicardial coronary compression that is reversible after pericar-diotomy, is rarely encountered. This may result from constraining of the coronary artery by the calcified pericardial cystic mass or an external pressure against an expanding myocardium during ventricular filling that compresses the vessel against the fixed noncompliant pericardium, leading to myocardial ischemia.…”