Recurrent postoperative effusive-constrictive pericarditis potentially associated with steroid discontinuation was suspected and she had steroid medication (1 mg/kg daily) again. The tapering of steroid was more slowly over 8 months with the improvement of symptoms and signs. Chest X-ray showed normalized heart size VE-821 purchase within 1 week (Fig. 1G) and in 6 months Inhibitors,research,lifescience,medical (Fig. 1H) after re-treatment

with steroid. At present, she is free of symptom with warfarin only. Discussion Transient effusive-constrictive pericarditis is a rare complication of open-heart surgery but important disease entity, since these patients are not indicated for pericardiectomy. Transient effusive-constrictive pericarditis was originally described in the English literature by Sagristá-Sauleda et al.1) in 1987. Transient Inhibitors,research,lifescience,medical inflammation or fibrosis of the pericardium associated with viral or bacterial infection or immunologic mechanism after acute effusive pericarditis has been proposed as a mechanism of this transient effusive-constrictive pericarditis.2) In 2004, Haley et al.3) described 36 patients who met the criteria Inhibitors,research,lifescience,medical for the diagnosis of transient constrictive pericarditis. At that reports, they described that the

causes for the transient constrictive pericarditis were diverse and most common cause was prior cardiovascular surgery (25%). In Korea, Yang et al.4) reported 11 patients with transient constrictive pericarditis Inhibitors,research,lifescience,medical in 2001. They showed that tuberculosis (10/11 patients)

was the most important etiology of transient constrictive pericarditis in Korea. Postpericardiotomy syndrome develops days to months after cardiac and pericardial injury.5),6) Management of the postpericardiotomy syndrome is basically symptomatic and random combinations of non-steroidal anti-inflammatory agents, colchicines and steroid have been being applied. Recently, Imazio et al.7) showed that most of recurrent pericarditis might be an autoimmune disease and colchicine plus conventional therapy led to a clinically Inhibitors,research,lifescience,medical important and statistically significant benefit over conventional treatment, decreasing the recurrence rate in patients with a first episode of acute pericarditis.8) But their study included acute pericarditis of diverse causes (idiopathic, viral, and autoimmune causes, including postpericardiotomy syndromes and connective tissue diseases). Thus, it is not certain if their results could be applied to postpericardiotomy syndrome patients. The major either adverse clinical event of postpericardiotomy syndrome is recurrence of pericarditis and optimal management of recurrent postpericardiotomy syndrome has not been also established. Our case is postpericardiotomy syndrome with pericardial effusion and constrictive physiology. After administration of steroid and ibuprofen, the constrictive physiology was dramatically resolved. However, there was a recurrence of constrictive physiology after rapid steroid discontinuation.