Case report: Epstein–Barr virus and constrictive pericarditis—An unusual combination

Figures

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  Figure 1. (A) Transthoracic echocardiography before cardiac surgery. (B) Transthoracic echocardiography after cardiac surgery.

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  Figure 2. Cine steady-state free precession four- and two-chamber view images show circumferential pericardial effusion (A,B), with uniform pericardial thickening at T1-weighted short-axis view image (C). There is no significant hyperintense signal on the edema-weighted image (D) while a marked late gadolinium enhancement of pericardial layers is evident (E,F), suggesting diffuse pericardial fibrosis. Short-axis real-time cine MRI sequence during operator-guided breathing (G,H) demonstrates an abnormal displacement of the interventricular septum during the onset of inspiration, due to a fixed pericardial volume with reduced ventricular compliance and consequent increase of the right ventricular filling on inspiration.

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  Figure 3. Normally, there is a concordant fall in LV and RV pressures in inspiration. In constriction, there is discordance of LV and RV pressure changes in inspiration: the LV pressure falls, and the RV pressure rises. Also, the ventricular pressure tracings show an early diastolic dip in pressure followed by a plateau phase due to rapid early diastolic filling and subsequent restriction in filling (square root sign or dip and plateau sign).

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  Figure 4. Specimen of anterior parietal layer pericardium post-pericardiectomy.