Constrictive pericarditis refers to inflammation of the pericardial sac, possibly leading to acute heart failure. More than 80% cases are presumed to be due to recent or remote viral illnesses. Prominent features include chest pain, dyspnea and electrocardiogram (ECG) revealing P-R segment depression, diffuse concave ST segment elevation, and T-wave inversion. Echocardiogram and cardiac magnetic resonance imaging (MRI) can help establish diagnosis. Over time, the pericardium can undergo fibrosis or calcification resulting in excessive symptoms. After medical management with ibuprofen, colchicine or steroids, partial or complete pericardiectomy is considered. We are presenting a case with constrictive pericarditis due to extensive pericardial calcification, and ultimate resolution with pericardiectomy.

Objectives: The aim of this analysis was to evaluate the predictors associated with increased risk of permanent pacemaker implantation (PPMI) following Transcatheter Aortic Valve Replacement (TAVR). Background: While TAVR has evolved as the standard of care for patients with severe aortic stenosis, conduction abnormalities leading to the need for PPMI is one of the most common post-procedural complications. Methods: A systematic literature search was performed to identify relevant trials from inception to May 2020. Summary effects were calculated using a DerSimonian and Laird random-effects model as odds ratio with 95% confidence intervals for all the clinical endpoints. Results: 37 observational studies with 71,455 patients were identified. The incidence of PPMI following TAVR was 22%. Risk was greater in men and increased with age. Patients with diabetes mellitus, presence of right bundle branch block, baseline atrioventricular conduction block, and left anterior fascicular block were noted to be at higher risk. Other significant predictors include the presence of high calcium volume in the area below the left coronary cusp and non-coronary cusp, use of self-expandable valve over balloon-expandable valve, depth of implant, valve size/annulus size, pre-dilatation balloon valvuloplasty and post-implant balloon dilation. Conclusion: Fourteen factors were found to be associated with increased risk of PPMI after TAVR, suggesting early identification of high-risk populations and targeting modifiable risk factors may aid in reducing the need for this post TAVR PPMI.