Acute Transient Effusive-Constrictive Pericarditis

Figures

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  Figure 1. On Admission (A, B) Echocardiography shows moderate pericardial effusion and restricted wall motion of the right atrium and ventricle. (A) Apical 4-chamber view. (B) Parasternal long-axis view. (C) An arterial pressure tracing shows pulsus paradoxus. (D) Initial diastolic mitral flow velocity. See Videos 1 and 2. E = expiration; I = inspiration; LV = left ventricle; RV = right ventricle.

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  Figure 2. After the Pericardiocentesis, Day 2 (A, B) Echocardiography (parasternal long-axis and short-axis views, respectively) confirms no residual pericardial effusion and shows normal left ventricular systolic function. (C) Arterial pressure tracing after pericardiocentesis shows disappearance of pulsus paradoxus. (D) Diastolic transmitral flow velocity shows increased respiratory variation (32%). See Videos 3 and 4. Abbreviations as in Figure 1.

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  Figure 3. Pressure Measurements, Day 4 (A)Simultaneous right and left heart pressure measurements. (B) Discordant respiratory variation of the left and right ventricular pressures (red and black arrows) suggests interventricular dependence. Ao = aorta; PA = pulmonary artery; RA = right atrium; WP = pulmonary capillary wedge pressure; other abbreviations as in Figure 1.

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  Figure 4. Plain Computed Tomography Scans on Day 4 and at 6 months (A) Day 4 shows the thickened pericardium (arrows). (B) At 6 months.

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  Figure 5. Echocardiography, Day 10 (A, B) Echocardiography (parasternal long-axis and short-axis views, respectively) shows marked improvement. (C) Variation in diastolic transmitral flow velocity is improved. See Videos 5 and 6.