A 61-year-old man presented with a 4-month history of progressive biventricular failure with predominantly right heart symptoms. He had a history of tuberculosis pericarditis and type 2 diabetes mellitus. He was hospitalized with dyspnea, edema of the lower extremities, and pleural effusion. Computed tomography showed noncalcified pericardial thickening (Fig. 1). Coronary angiography detected major multivessel disease (Fig. 2) and an echocardiogram showed that the ejection fraction was 53% and fractional shortening was 27%. An electrocardiogram indicated sinus rhythm, left precordial lead low voltage, and T-wave alternans. Combined detection of cardiac markers (electrochemiluminescence) showed the following: N-terminal pronatriuretic peptide level, 1098 pg/ml; creatine kinase isoenzyme MB level, 2.42 ng/ml; myoglobin level, 21.00 ng/ml; and quantitative serum cardiac troponin T level, 18.26 ng/ml. The patient refused to have revascularization. Therefore, only pericardiectomy was performed.
With the support of IABP, pericardiectomy was performed through median sternotomy under general anesthesia. After the operation, central venous pressure declined from a preoperative value of 18 mmHg to a postoperative value of 5 mmHg. The postoperative course was uneventful. The patient was extubated within 24 h and discharged with oral medications for coronary artery disease 21 days after the operation. A histological examination of resected pericardium confirmed chronic inflammation (Fig. 3). After 6-months' follow-up, the patient remained in New York Heart Association class I functional status with complete resolution of pleural effusion (Fig. 4). Written informed consent was obtained from the patient for publication of this manuscript and any accompanying images.