Background: The presence of constrictive pericarditis (CP) in conjunction with tricuspid regurgitation (TR) and the worsening of TR following pericardiectomy are associated with a reduction in patient survival. The purpose of this study was to investigate the prevalence of tuberculous CP in conjunction with TR, the incidence of worsening regurgitation following pericardiectomy, and the analysis of associated factors. Methods: Seventy-five consecutive patients who underwent pericardiectomy for tuberculous CP at the institution between January 2021 and December 2023 were retrospectively analyzed. Their clinical, imaging, and hemodynamic characteristics were analyzed. Results: Among the 75 patients with tuberculous CP, 29 patients (38.7%) had mild or greater TR preoperatively and 27 patients (36%) had worsening TR after pericardiectomy. In patients with worsening TR, the pericardial thickness of the right ventricular (RV) lateral wall was significantly thickened preoperatively, and there was a reduction in the tricuspid annular plane systolic excursion (TAPSE), right ventricle S’ tissue Doppler velocity (S’), and right ventricle fractional area change (FAC) postoperatively. The preoperative inferior vena cava diameter and the postoperative right atrial and RV basal diameters were significantly larger in patients with worsening TR compared with patients with non-worsening TR, whereas the TAPSE, S’, and FAC were significantly lower before and after the surgery (P < .05). The FAC [OR = 0.354; 95% CI (0.165-0.761), P = .008] and pericardial thickness of the RV lateral wall [OR = 1.887; 95% CI (1.206-2.953), P = .005] were independently associated with worsening TR. Conclusion: Patients with tuberculous CP often have coexisting TR, and pericardiectomy can lead to worsening TR. The pericardial thickness of the RV lateral wall and FAC are independently associated with worsening TR following pericardiectomy.

Extramedullary involvement of the endocardium is rare in multiple myeloma. Here we describe a case of multiple myeloma (plasma cell) with extramedullary plasmablastic transformation and endocardial involvement, which resulted in partial superior vena cava obstruction. We also conducted a literature review and summary analysis of space-occupying lesions in the heart in 12 patients with multiple myeloma (including the current case) in the last 10 years. Echocardiography is the preferred radiologic examination method for diagnosis and follow-up in multiple myeloma, and surgical resection is effective for alleviating symptoms.

An 80-year-old female patient with a pacemaker was found massive pericardial effusion, and the sagittal image of CTA revealed the atrial lead tip extended slightly beyond the atrial wall. During operation, we found the criminal lead keep going in and out of the atrial wall and appearing as a dot when penetrated. This case gives us a lesson on diagnosis of lead perforation in patients with pacemakers.

To the Editor, The authors 1 are thanked for their interest and valuable comments on the article "Tricuspid Regurgitation in Tuberculous Constrictive Pericarditis Underwent Pericardiectomy." 2 Tuberculosis infection is the main cause of constrictive pericarditis (CP) in developing countries, accounting for approximately 38%-83% of all CP cases. Currently, pericardiectomy is the only effective treatment for CP. 3 Studies have shown that both CP combined with tricuspid regurgitation (TR) and worsening TR due to pericardiectomy reduce long-term survival. This phenomenon that deserves attention in the preoperative evaluation by surgeons. 4-7 There is no consensus on the mechanism of coexisting TR in CP. It is believed that TR is secondary to the structural and functional remodeling of the patient's right atrium and right ventricle during the pathological processes of CP and that the patient's combination of underlying diseases, such as arrhythmia, pacemaker implantation, and chronic lung disease, is an important influencing factor. In tuberculous CP, the presence of inflammatory factors that damage the valvular apparatus deserves further research and discussion. In CP, worsening TR is associated with right ventricular systolic dysfunction. Meanwhile, impaired right ventricular systolic function complicates the treatment of pericardiectomy and reduces long-term patient survival. This makes a detailed assessment of right ventricular morphology and function particularly important. Currently, echocardiographic assessment of right ventricular systolic function is mainly based on right ventricular fractional area change, tricuspid annular plane systolic excursion, and right ventricular S' tissue Doppler velocity, as mentioned in the article, but it can be considered using speckle tracking imaging, 3-dimensional echocardiography or even magnetic resonance imaging to assess right ventricular morphology, local myocardial function, and degree of fibrosis in detail. Thank you again for agreeing with the viewpoint of the article. For tuberculosis CP, we will prospectively study the patients through various aspects, including clinical, blood biochemical, multimodal imaging, and prognostic aspects, to understand the mechanism of worsening TR and the factors and extent of right ventricular myocardial injury. This will provide more information for surgical strategies and improve the long-term prognosis of patients.