[IgG4-related constrictive pericarditis treated by waffle procedure].

A 59-year-old man was admitted for evaluation of short of breath and bilateral leg edema that had progressively worsened over 3 months. Chest computed tomography revealed marked pericardial thickening. Cardiac echocardiography revealed right heart volume load and diastolic dysfunction. Cardiac catheterization revealed a dip-and-plateau pattern of the pressure curve of right ventricule (RV)without any coronary disease. On a diagnosis of heart failure due to pericardial constriction, he underwent pericardiectomy under cardiopulmonary bypass. Multiple longitudinal and transverse incisions like a waffle were made in the thickened epicardium and improved the hemodynamics. The symptoms improved after surgery. As serum level of immunoglobulin G(IgG)4 was elevated and IgG4-positive plasma cells were recognized in the resected pericardium, diagnosis of constrictive pericarditis of hyper-IgG4 disease was made.