From Infection to Constriction: Successful Surgical Resolution of Constrictive Pericarditis Following Purulent Pericarditis

Constrictive pericarditis (CP) is a rare but serious condition characterized by pericardial fibrosis and impaired ventricular filling, often resulting in progressive heart failure. Infectious pericarditis, particularly purulent forms, is a severe etiology requiring early recognition and intervention. A 64-year-old male with a history of <i>Staphylococcus aureus</i> pericarditis presented with worsening dyspnea and signs of right heart failure. Imaging revealed a thickened, fibrotic pericardium with mild effusion, while cardiac catheterization confirmed CP with equalized diastolic pressures and a dip-plateau phenomenon. Given his clinical deterioration, he underwent subtotal pericardiectomy with pericardial reconstruction. Intraoperatively, severe adhesions were noted, necessitating extensive pericardial resection. The patient showed rapid postoperative improvement, with a resolution of heart failure symptoms and normalization of right ventricular function. This case highlights the importance of timely diagnosis and surgical intervention in CP following infectious pericarditis. Pericardiectomy remains the definitive treatment, with early recognition being key to optimizing patient outcomes.