Loculated Pericardial Effusion

Figures

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  Figure 1. Right-Sided Heart Catheterization Tracings Elevated right atrial and pulmonary capillary wedge pressure with an early diastolic dip and plateau pattern in the right ventricular tracing. There is near equalization of the right ventricular end-diastolic, pulmonary capillary wedge, right atrial, and pulmonary artery diastolic pressures, thus raising suspicion of pericardial constriction or possibly restriction.

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  Figure 2. Transthoracic Echocardiogram A large loculated pericardial effusion (Peri) causing compression of the left atrium (LA) and left ventricle (LV) as seen in the (A) parasternal long-axis view at end-diastole, (B) parasternal long-axis view at midsystole with mitral regurgitation, and (C) apical 4-chamber view at end-diastole. (D) The apical 3-chamber view demonstrates anterior displacement of the mitral apparatus with systolic anterior motion of the mitral valve (arrow). (E) There is a later peaking gradient of 18 mm Hg across the left ventricular outflow tract at rest and (F) a 9 mm Hg peak gradient by pulse-waved Doppler proximal to the left ventricular outflow tract. RA = right atrium; RV = right ventricle.

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  Figure 3. Intraoperative Transesophageal Echocardiogram (A) Systolic anterior motion of the mitral valve with (B) significant mitral regurgitation secondary to systolic anterior motion of the valve and pseudo-prolapse of the posterior leaflet (arrow in A). (C) The loculated pericardial effusion (Peri) is associated with left ventricular diastolic collapse and compression of the mitral valve apparatus as seen in the transgastric short-axis view. (D) The coagulum within the loculated pericardial effusion is displayed in cross plane. LA = left atrium; LV = left ventricle.