Contractile pericarditis-like hemodynamics in dilated-phase hypertrophic cardiomyopathy with giant atrium

A 47-year-old man with dilated-phase hypertrophic cardiomyopathy was admitted to the hospital with worsening heart failure. As the enlarged atrium caused a constrictive pericarditis-like hemodynamic condition, atrial wall resection and tricuspid valvuloplasty were performed. Postoperatively, pulmonary artery pressure rose due to increased preload; however, the rise in pulmonary artery wedge pressure was restrained, and the cardiac output significantly improved. When the pericardium is extremely stretched due to atrial enlargement, it can lead to an elevation of intrapericardial pressure, and both atrial volume reduction and tricuspid valve plasty could lead to increased compliance and contribute to hemodynamic improvement. Learning objective: Atrial wall resection for massive atrial enlargement and tricuspid annuloplasty in patients with diastolic-phase hypertrophic cardiomyopathy effectively relieves unstable hemodynamics.