P219 EXTRINSIC COMPRESSION OF THE RIGHT VENTRICLE CAUSING ISOLATED RIGHT HEART FAILURE

Abstract Isolated right heart failure (RHF) can be caused by ventricular (RV) compression, mainly described in severe cases of pectus excavatum. Mediastinal masses determine an extrinsic compression the RV. A 62–year–old retired agricultural inspector from Sicily presented our clinic with worsening signs RHF. His medical history consisted echinococcosis familiarity, surgically treated congenital subvalvular aortic stenosis, resulted a residual moderate insufficiency and permanent atrial fibrillation. Around January 2021 he developed isolated leg swelling. Aortic valvular dysfunction, other cardiogenic explanations were excluded. year later dyspnea (NYHA class II) appeared. High resolution CT demonstrated fluid collection peripheric calcifications inside anterior mediastinum. PET showed uptake limited zone The patient slowly started developing ascites, hardly manageable diuretics because kidney failure. Transthoracic echocardiography (TTE) highlighted mild RV dysfunction (FAC 35%) free wall hypokinesia due to mediastinal mass compression. Transesophageal heterogeneous cystic aspect mass, oscillating intraventricular cuspid (6x4 mm) mitral annular calcification. In consideration history, endocarditis was considered. Cardiac magnetic resonance recognized features. Echinococcous serology antibodies negative but Quantiferon tested positive. Laboratory tests absolute eosinophilia high CD4/CD8 ratio. Because severely compromised hemodynamic balance removed identified as pseudocystic tuberculoma. After excision, improved TTE restored function persistent increased atrium pressure. this clinical case RHF determined extracardiac which interfered absence any left mechanical action on reduction ejected volumes, surgical option only possible strategy avoid following