case_images: PMC9290158_01
case_images: Echocardiogram (A) parasternal long axis, (B) parasternal short axis, and (C) apical 4 chamber. Moderate pericardial effusion (arrows) and moderately dilated right atrium and left atrium.
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case_images: An echocardiogram showed moderate pericardial effusion, dilated right and left atria (Figure 1), and severe tricuspid regurgitation with a right ventricular systolic pressure of 41 mm Hg.
case_images: Anatomic pathology after pericardial window. Pericardial tissue with reactive mesothelial cells (arrows) at (A) 10x and (B) 20x.
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case_images: The anatomic pathologic results on the pericardial tissue sample showed only reactive mesothelial changes (Figure 2).
case_images: Cardiac magnetic resonance imaging (CMR) showing pericardial effusion (A-C). Bilateral pleural effusion (A, B). Small ascites (A). Ventricular septum flattening during inspiration (C).
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case_images: Cardiac magnetic resonance (CMR) imaging showed moderate pericardial effusion with flattening of the interventricular septum during inspiration, small bilateral pleural effusion, ascites, and normal myocardium (Figure 3).
case_images: (A) Right atrial pressure tracing showing prominent Y descent (arrows). (B) Equalization of biventricular end-diastolic pressures (circle) with pronounced right ventricular rapid filling wave >7 mm Hg.. Abbreviations: LV, left ventricle; RV, right ventricle.
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case_images: The pressure waveform showed prominent Y descent with pronounced right ventricular rapid filling wave the "square root sign" (Figure 4).
case_images: Studies post fistula closure. Left and right heart cardiac catheterization (A and B) showing (A) normal right atrial pressures, prominent Y descent no longer present. (B) There is no equalization of end-diastolic pressures or pronounced right ventricular rapid filling wave. Follow-up echocardiogram 1 month after AV fistula closure (C and D) showing only mild pericardial effusion (arrow).. Abbreviations: LV, left ventricle; RV, right ventricle.
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case_images: An echocardiogram showed a small amount of pericardial effusion and mild tricuspid regurgitation. A repeat cardiac catheterization revealed resolution of the constrictive physiology with normalization of right and left heart hemodynamics (Figure 5; Table 1).