Case Report: A rare coexistence in children: constrictive pericarditis, atrial septal defect, and cardiac diverticulum

Figures

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  Figure 1. Preoperative TTE and contrast-enhanced cardiac CT images. (a) Subcostal bicaval view demonstrating an ASD with a left-to-right shunt. (b) Apical four-chamber view showing pericardial thickening associated with pericardial effusion. (c) M-mode tracing from the parasternal long-axis view revealing septal bounce in early diastole. (d) Apical four-chamber view showing a cystic structure at the right ventricular apex. (e) Pulsed-wave Doppler demonstrating >25% respiratory variation in early diastolic tricuspid valve inflow velocity. (f) Contrast-enhanced cardiac CT showing a contrast-filled outpouching at the right ventricular apex.

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  Figure 2. Intraoperative TEE images and pathological findings. (a) TEE demonstrating two shunting jets across the atrial septum. (b) TEE revealing a cystic structure at the right ventricular apex with no detectable color-flow signal. (c) Intraoperative view showing a thickened, adherent, grayish-white pericardium. (d) Histopathological examination revealing fibrous tissue hyperplasia with hyaline degeneration (hematoxylin and eosin staining, original magnification ×20).

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  Figure 3. TTE images following pericardiectomy. (a) On the first postoperative day, TTE shows communication between the right ventricle and the apical outpouching. (b) Spectral Doppler at the neck showing a bidirectional flow signal. (c) Three-dimensional TTE showing two defects in the atrial septum, with the delivery sheath advanced through a large defect. (d) Three-dimensional TTE confirming complete seating of the double-disc occluder. (e) TTE demonstrating a well-positioned occluder without a residual shunt on the eighth postoperative day. (3f) Apical four-chamber view showing a persistent diverticulum.