[A case of constrictive pericarditis with atrial fibrillation after mitral valve repair and Maze III procedure].

We report a case of constrictive pericarditis with atrial fibrillation after mitral valve repair and the Maze III procedure. A 66-year-old male underwent mitral valve repair and the Maze procedure for mitral valve regurgitation and chronic atrial fibrillation. About 4 months after discharge, he suffered from shortness of breath. Physical examination revealed a heart rate of 80 beats/min with irregular rhythm, external jugular venous dilatation and abdominal ascites. Electrocardiography revealed atrial fibrillation, and chest X-ray revealed moderate left pleural effusion. Computed tomographic images of the chest showed a that thickened pericardium. A distinct diastolic dip and plateau pattern were recognized on cardiac catheterization. The right atrial, right ventricular end-diastolic, and pulmonary wedge pressures were elevated. Idiopathic pericarditis and recurrent atrial fibrillation were diagnosed and pericardiectomy was performed through a median sternotomy incision. Intraoperatively, the atrial fibrillation converted spontaneously to sinus rhythm. The postoperative hemodynamics improved after pericardiectomy. Total pericardiectomy alone may not convert the rhythm to sinus rhythm in patients with constrictive pericarditis and chronic atrial fibrillation. In this case, atrial fibrillation converted to sinus rhythm during the procedure. This case report suggests that adequate unloading of atrial pressures is necessary for the maintenance of sinus rhythm in patients who have undergone the Maze procedure.