In the following months our patient became spontaneously asymptomatic and tolerated physical exercise better and better. He had no fever, and no new syncope. Standard laboratory analyses were completely normal. Rheuma factor, anticardiolipin antibodies and 3 sputum PCR tests for tuberculosis were all negative. In the follow-up 24h EKG Holter monitoring (May 2004) there were no significant rhythm or conduction disorders apart from a single episode of IIIrd degree SA block with a 1.1 s pause and a permanent Ist grade AV block. Echocardiography also confirmed his recovery: ESVI decreased to 15.7 ml/m2 and LVEF increased to 74%. No pleural or pericardial effusion was present any more, and despite hyperechogenic signal from the entire pericardium there were no other echocardiography signs of constrictive pericarditis or restrictive cardiomyopathy. Chest x-ray (PA and left profile) revealed normal findings with no signs of calcifications. On follow-up cardiac catheterization, including exercise test on the lying bicycle-ergometer, volume challenge test, and dobutamine test there was no "dip-plateau" configuration in the ventricular curves, or other signs of constriction. During the lying bicycle stress test cardiac index increased from 4.1 at the baseline to 21.2 l/min/m2 at 250W. Ergospirometry, head-up tilt table test, and repeated Holter monitoring, echocardiography, and MRI revealed normal findings.
According to the international guidelines for competitive sports constrictive pericarditis is a clear indication for cessation of the professional career and pericardiectomy. However, before making the final decision on the management, indications for surgery and permanent withdrawal from sports should be reassessed on several occasions, since, although rarely but still, constriction could be spontaneously transient with complete recovery of cardiac function, enabling successful return to competitive sports.
After comprehensive and repeated haemodynamic assessment, we have allowed him in September 2004 to continue his career of professional football player. During the further three years of follow - up there was no recurrence of pericardial constriction or other heart disease. Our patient is now a permanent member of the Serbian national team and very successfully plays in the French 1st football league!
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