Pericardial Constriction with Severe Mitral Regurgitation

Pericardial constriction is a condition, in which there is a lack of transmission of changes in intrathoracic pressures to the structures encased in pericardium due to thickened, fibrosed, and most of the cases, calcified pericardium. A 24-year-old male presented to us in right heart failure. There was a history of diagnosis of acute rheumatic fever with carditis in childhood. X-ray and echocardiogram gave us a probable diagnosis of rheumatic constrictive pericarditis (CP) with mitral regurgitation (MR). The diagnosis of CP was confirmed with computed tomography chest and invasive hemodynamic assessment. He had significantly elevated pulmonary artery (PA) pressures and elevated left ventricular dip diastolic pressures, which were unexpected findings. We have discussed the probable causes of associated MR and elevated PA pressures in this case report. We have also tried to differentiate CP from restrictive cardiomyopathy, specifically endomyocardial fibrosis, which is common in the state of Kerala.