This is a still-frame of a left ventriculogram in the right anterior oblique view from a patient with constrictive pericarditis. The tip of the pigtail catheter is in the left ventricle. Contrast material has been injected into the left ventricle and is seen in the aorta, as a normal result of ventricular ejection.
The arrows outline the thickened, calcified pericardium.
In the real-time study that follows, note the normal systolic function of the left ventricle and the immobility of the pericardium.
LV and RV pressure curves
These simultaneous left and right ventricular pressure tracings are from the patient whose left ventriculogram was shown and are typical for constrictive pericarditis. Only the lower portion of the left ventricular curve is seen. Note that in diastole the pressures are elevated and the left and right ventricular pressure curves superimpose and show the classic early diastolic dip and plateau pattern of abnormal filling, sometimes called the square root sign. The same pattern may be seen in restrictive cardiomyopathy.
Constrictive pericarditis RA pressure curves
A typical catheterization study in constrictive pericarditis shows "M" or "W" shape right atrial pressure curves due to the prominent "x" and "y" descents. Note also the inspiratory increase in right atrial pressure referred to as Kussmaul's sign. During inspiration, augmented return to the right heart occurs. However, because of the limitation due to the constriction of the pericardium, the normal dilation of the right heart is prevented and the venous pressure rises.