case_images: PMC11742340_01
case_images: Right heart catheterization (RHC) showing the simultaneous right and left heart ventricular curves. In constrictive pericarditis, exaggerated ventricular interdependence in RHC should demonstrate that the area under the right ventricular systolic pressure curve increases during inspiration, whereas the area under the left ventricular systolic pressure curve decreases. In our patient, although the area under the left ventricular pressure curves decreases slightly, there isn't a significant change in the right ventricular ones, even after fluid challenge
case_images: 10554_2024_3235_Fig1_HTML.jpg
case_images: PMC11742340_01_10554_2024_3235_Fig1_HTML.jpg
case_images: Fig1
case_images: However, it wasn't able to show dissociation between pulmonary capillary wedge pressure and left ventricle end-diastolic pressure with respiration nor exaggerated ventricular interdependence (Fig. 1), which couldn't confirm the diagnosis of CP.
case_images: Absence of exaggerated ventricular interdependence on free-breathing protocol of cardiac magnetic resonance (CMR) (A and B) due to marked diuresis. After the interruption of diuretics for one week, a clear phenomenon of exaggerated ventricular interdependence is seen in CMR images (C and D), with ventricular septal shift with respiration cycle: rightward shift of septum during expiration (C) and leftward shift of septum during inspiration (d)
case_images: 10554_2024_3235_Fig2_HTML.jpg
case_images: PMC11742340_01_10554_2024_3235_Fig2_HTML.jpg
case_images: Fig2
case_images: After one week of interruption of diuretics, a second CMR demonstrating pericardial thickening, exaggerated ventricular interdependence with ventricular septal shift and diastolic interventricular septal bounce (Fig. 2), gave the answers to our dilemma.