ECMO-Supported Pericardiectomy in Constrictive Tuberculous Pericarditis With Severe Ventricular Dysfunction

BACKGROUND: Constrictive pericarditis is a well-recognized complication of tuberculous pericarditis, whereas severe ventricular systolic dysfunction is rare. CASE SUMMARY: A 20-year-old man presented with progressive heart failure and was found to have severe biventricular systolic dysfunction (left ventricular ejection fraction <15%) with marked pericardial thickening. Conventional investigations for tuberculosis were negative. Despite empirical antituberculosis therapy and optimal heart failure treatment, he continued to deteriorate and subsequently underwent radical pericardiectomy. The postoperative course was complicated by cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation. Histopathology and polymerase chain reaction on pericardial tissue confirmed tuberculosis. Bi-ventricular systolic function subsequently recovered to normal. DISCUSSION: In the absence of myocardial fibrosis or myocarditis on cardiac magnetic resonance, the reversible severe systolic dysfunction was most likely due to mechanical constraint. TAKE-HOME MESSAGE: Advanced constrictive tuberculous pericarditis can manifest with profound but reversible ventricular systolic dysfunction, and timely pericardiectomy can be lifesaving.