Constrictive Pericarditis After Repair of a Ruptured Sinus of Valsalva

Background: Constrictive pericarditis is an uncommon complication of cardiac surgery. We report a patient who developed constrictive pericarditis after ruptured sinus of Valsalva (RSOV) repair.Methods: A 23-year-old male presented with exertional dyspnea one year after RSOV repair. TTE showed a small, circumferential effusion with thickened pericardium, ventricular septal bounce, left atrial enlargement, diastolic hepatic flow reversal, and trivial mitral regurgitation without stenosis. He underwent cardiac catheterization, which revealed elevated filling pressures (RVEDP 16 mmHg, LVEDP 18 mmHg), RVEDP/RVSP ratio < 0.5, and a low cardiac index (1.65 L/min/m2). Cardiac MRI confirmed pericardial thickening with paradoxic septal motion, dilated pulmonary veins and retrograde flow in the SVC.Results: Pericardiectomy of thickened and adherent pericardium was performed. The central venous pressure decreased from 23 to 7 mmHg and TEE showed normal systolic function with less septal bounce posteroperatively. Pathology specimens of the pericardium exhibited fibrosis and mild chronic inflammation. He continued to do well at one-month follow-up.Conclusion: Constrictive pericarditis is a rare complication of cardiac surgery. In patients presenting with right sided heart failure and deterioration of cardiac function not explained by other mechanisms, evaluation with TTE and cMRI should be considered; cardiac catheterization with or without fluid challenge can be performed to confirm the diagnosis.