Constrictive Pericarditis After Minimally Invasive Triple Valve Replacement: Insights From a Fatal Outcome

Triple valve surgery is performed in only a small minority of valvular procedures and carries substantial perioperative risk and a demanding postoperative course. Pericardial complications after cardiac surgery are well recognized, but progression to constrictive physiology following a minimally invasive triple valve operation is exceptionally uncommon and poorly characterized. We describe an elderly woman with longstanding hypertension, dyslipidemia, and paroxysmal atrial fibrillation who underwent minimally invasive replacement of the aortic, mitral, and tricuspid valves for combined multivalvular disease. Her recovery was complicated by recurrent pleural and pericardial effusions that evolved into constrictive pericarditis, with clinical and imaging features supporting the diagnosis, although distinguishing it from a restrictive process remained challenging despite complementary multimodality imaging and invasive hemodynamic assessment. Although pericardiectomy was undertaken, she deteriorated into refractory cardiogenic shock and died shortly afterwards. This report illustrates the difficulty of distinguishing constriction from restriction in the postoperative setting and underscores the value of close multidisciplinary follow-up after extensive valve surgery in older patients.