Diagnostic Dilemma of Constrictive Pericarditis with Concomitant Mitral Stenosis: A Case Report

Constrictive pericarditis (CP) is due to impediment of cardiac diastolic filling secondary to an inelastic and fibrotic pericardium [1]. Observation of this phenomenon is paramount in the understanding of the pathophysiology through several mechanisms. Firstly, there is dissociation of intra-thoracic and intra-cardiac pressure during respiration leading to respiratory variation of mitral and tricuspid inflow velocities. Secondly, there is ventricular interdependence causing septal bouncing observed on echocardiography during the respiratory cycle. Thirdly, there is impairment of diastolic filling causing an abrupt pause in mid to late diastole. This can be demonstrated during cardiac catheterization as dip-and-plateau ventricular pressure tracing or square root sign. Pericardial calcification is common in CP. It is classically described as “eggshell” or amorphous calcification in the atrioventricular groove.