Case Report: A rare coexistence in children: constrictive pericarditis, atrial septal defect, and cardiac diverticulum

This report describes a rare case of a girl with constrictive pericarditis (CP), coexisting with atrial septal defect (ASD) and cardiac diverticulum. Her echocardiographic features changed in accordance with the hemodynamic alterations as treatment progressed. During a routine echocardiography before surgery, a 9-year-old girl with ASD was unexpectedly diagnosed with CP. This explains why her symptoms and signs were inconsistent with isolated ASD, including lower limb edema and hypoalbuminemia caused by impaired diastolic ventricular function. Contrast-enhanced computed tomography confirmed the diagnosis of CP and identified a right ventricular diverticulum. To minimize surgical trauma, a step-by-step surgical approach was adopted. Complete pericardiectomy without cardiopulmonary bypass was first performed to alleviate the pathophysiological abnormalities of CP, followed by percutaneous ASD closure to reduce the excessive right heart volume overload. The diverticulum was not treated because of its small size. The patient had an uneventful postoperative recovery.