The waffle procedure as treatment of a first episode of right heart failure: a case report

BACKGROUND: Constrictive pericarditis is a rare condition which is characterized by pericardial layers thickening and it may not be relieved by conventional medical or surgical therapies. Some patients could profit from specific surgical techniques such as the waffle procedure which removes epicardial tissue strips of the visceral layer of the pericardium. It alleviates diastolic dysfunction, since it is known that the constrictive physiology observed in constrictive pericarditis depends mainly on the visceral layer. CASE SUMMARY: We describe the case of a 59-year-old male complaining of predominantly right heart failure symptoms. Initially, a transthoracic echocardiogram showed pericardial effusion with several fibrous tracts and a constrictive pattern. The work-up was completed with thoracic computed tomography and right heart catheterization along with several microbiological, serological and immunological tests. The final diagnosis was idiopathic constrictive pericarditis. The clinical course was unfavourable, and the patient was referred for prompt surgical treatment using a technique called the waffle procedure. Subsequently, the patient has remained asymptomatic. DISCUSSION: Constrictive pericarditis combines features of both constriction and tamponade. Some patients may present an unfavourable clinical course with conventional therapeutic approaches. They could benefit from the waffle procedure which allows an improvement in diastolic and, subsequently, in systolic function.