Клиническая и экспериментальная кардиология
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Conical Deformity of the Left Ventricle: A Case Report

Rogerio Teixeira, Nadia Moreira, Rui Martins, Fatima Franco and Luis Providencia

Most published information on the diagnosis of constrictive pericarditis assumes that the left ventricle has normal or nearly normal systolic function. Noninvasive assessment of pericardial constriction remains crucial to the diagnosis, especially in high-risk subgroups of patients, such as patients after cardiac surgery.We present a 63-year-old Caucasian man who was admitted to the hospital for chronic decompensated heart failure. He had a past history of 3 open-heart surgeries for rheumatic heart valve disease. He was diagnosed with mixed pericardial and myocardial disease. The patient had a left ventricular ejection fraction of 38%, a functional mechanical aortic prosthesis, and a mechanical mitral prosthesis with elevated gradients. Severe pulmonary hypertension was present. The major findings that strongly suggested pericardial constriction were the presence of a conical deformity of the left ventricle, preserved indices of myocardial relaxation, and pericardial thickening. A reversed pattern of the velocities of diastolic relaxation was seen (lateral higher than septal), highlighting the possibility of mixed disease.This clinical case illustrates how noninvasive methods can be used to conclusively diagnose pericardial constriction in the presence of left ventricular systolic dysfunction.