The waffle procedure for the Rx of a first episode of RHF
Constrictive pericarditis is a rare condition which is characterized by pericardial layers thickening and it may not be relieved by conventional medical or surgical therapies. Some patients could profit from specific surgical techniques such as the waffle procedure which removes epicardial tissue strips of the visceral layer of the pericardium.

Published in the European Heart Journal - Case Reports, the authors describe the case of a 59-year-old male complaining of predominantly right heart failure (RHF) symptoms. Initially, a transthoracic echocardiogram showed pericardial effusion with several fibrous tracts and a constrictive pattern. The work-up was completed with thoracic computed tomography and right heart catheterization along with several microbiological, serological and immunological tests.

The final diagnosis was idiopathic constrictive pericarditis. The clinical course was unfavourable, and the patient was referred for prompt surgical treatment using a technique called the waffle procedure. Subsequently, the patient has remained asymptomatic.

Learning points:-

• Constrictive pericarditis results in mixed features of both constriction and tamponade and its symptoms are directly associated with right heart failure. As a consequence, diagnosis may be difficult and multiple imaging modalities are required in its diagnosis.

• Some patients could benefit from the waffle procedure which allows an improvement in diastolic and, subsequently, in systolic function.

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