(Figure 5)
Indications for ASD closure in childhood are well documented, and
treatment is known to be effective.3 Complications
including development of cardiac tamponade, recurrent pericardial
effusion or pericardial effusions requiring drainage after ASD closure
are rare.1,4–6 Furthermore, these pericardial
complications are usually reported in the peri-procedure period, as
compared to our patient who developed symptoms several months after
surgery.7 RP concomitantly with constrictive
physiology in these patients after a latent period has been sporadically
reported in the literature. A prior study of 15 cases on RP in children
and adolescents concluded that surgical ASD closure (n=6) was the
predominant underlying etiology .6 Interestingly, the
risk of development of PCIS presenting as RP is similar between
pediatric and adult populations.8
Echocardiogram and CMR supplemented clinical information to attain
diagnosis in our patient. CMR findings: mild LGE, right ventricular
tethering, diastolic septal bounce, and respirophasic shift supported
the diagnosis of recurrent pericarditis complicated by constrictive
physiology in our case.1 Short courses or abrupt
cessation of anti-inflammatory therapy without adequate tapering may
have resulted in residual pericardial inflammation, increasing his risk
of further flares. Treatment of pericarditis requires NSAIDs and
colchicine (as first line), steroids (second line), biologics such as
interleukin-1 receptor blockers or disease modifying anti-rheumatic
drugs (third line) and pericardiectomy (fourth line in refractory
cases).9,10
Our case represents a rare occurrence of RP with constrictive physiology
treated with pericardiectomy in an adolescent patient with prior
surgical ASD repair. Medical management of PCIS can be complicated due
to its prolonged duration and notable side effects. Further, it can be
an underdiagnosed or under-reported condition among adolescents.
Patients with ASD repair are living longer and require monitoring for
complications.11 Therefore, in order to improve their
outcomes it is imperative to timely identify the development of PCIS and
adequately manage it.