Recurrent cardiac constriction after pericardiectomy.

Dependent edema, ascites, and exertional dyspnea developed in a patient seven months after pericardiectomy for constrictive pericarditis. Cardiac catheterization documented constrictive physiology. At the second operation, he was found to have extensive mediastinal fibrosis that encased the heart. Postmortem examination showed a fibrocartilagenous exoskeleton that encased both ventricles. Possible etiologies for this unusual reconstriction are discussed.