C32 CONSTRICTIVE PERICARDITIS WITH PLATYPNEA ORTHODEOXIA

Abstract A 56–year–old woman is admitted to our centre for biventricular heart failure. In anamnesis she reports a submandibular phlegmon complicated by pleuropericarditis at the age of 13 years requiring repeated pericardiocentesis. last three has been hospitalised twice ascites and discharged with diagnosis idiopathic liver cirrhosis. On admission presented peripheral oedema, hippocratic fingers; oxygen saturation 80% in room air. blood tests creatinine, transaminases, albumin, coagulation NT–proBNP are normal, bilirubin elevated. An echocardiography performed showing calcific spicola impinging free wall right ventricle producing endocavitary obstruction; diffusely thickened pericardium, septal bounce, annulus reversus expiratory reflux suprahepatic veins. Biventricular contractile function normal no significant valvulopathy present. CT scan confirms presence diffuse pericardial calcifications, small irregular profile large ascitic effusion. Decongestive therapy started weight loss 22 kg regression oedema but severe hypoxia persists evidence platypnea–orthodeoxia syndrome. passage microbubbles left atrium from sixth beat onwards, compatible intrapulmonary shunt. arteriovenous malformation (AVM) lower pulmonary branch found angiography, which also revealed targeted invasive angiography. Cardiac catheterisation cardiac MRI confirmed constrictive pericarditis. Percutaneous closure AVM complete resolution subsequent pericardiectomy performed. The patient on day XXVII air, good haemodynamic compensation stasis parameters. conclusion, pericarditis rare cause failure knowledge this second case described reporting secondary