1Department of Clinical Laboratory, Third Kitashinagawa Hospital, 2Department of Internal Medicine, Third Kitashinagawa Hospital, 3Department of Internal Medicine, Kameari Hospital, 4Department of Cardiovascular Surgery, Kameda Medical Center, 5Department of Cardiovascular Surgery, Senpo-Takanawa Hospital
The low incidence of tuberculosis has made constrictive pericarditis (CP) a rare disease. CP has, however, been reported among patients who have undergone radiotherapy, heart surgery, and the like. One such case was that of a 36-year-old man who had been admitted on an emergency basis in 1991 and had undergone emergency surgery for hepatic trauma resulting from a traffic accident. Cardiac arrest occurred during surgery, but bimanual cardiac massage through the diaphragm was performed, and the patient recovered. Systemic edema and dyspnea on exertion developed and slowly and progressively worsened between 1993 and 1997. The patient was hospitalized again in 1997 for further evaluation. Echocardiography revealed overall thickening of the pericardium and paradoxical interventricular septal motion associated with CP. Doppler echocardiography showed a restrictive left ventricular inflow pattern, rapid deceleration of early filling, reduction in the E wave after inspiration, and respiratory change in the A wave. Cardiac catheterization showed elevated pressure in the right atrium and elevated end-diastolic pressure in the right ventricle, in addition to a pressure record of dip and plateau in the right ventricle, all of which are associated with CP. This case suggests the importance of long-term echocardiographic follow up of patients with histories of cardiopulmonary arrest who have been resuscitated by bimanual cardiac massage.