A Case Report of Constrictive Pericarditis: Step by Step Surgical Treatment of the Disease, Complications and Long-Term Outcomes

Abstract

Constrictive pericarditis (CP) is a chronic inflammation often characterized by chronic fibrosis, scaring, pericardial calcification, and associated with diastolic dysfunction, decreased cardiac output, and chronic heart failure. Early diagnosis of constrictive pericarditis is difficult due to absence of typical cardiopulmonary signs. In this case report, we present, a 20-years-old male. His initial disease and complains began with an increased size of the abdomen. Ultrasound showed a severe ascites with unknown cause for a long time. Only after a chest computed tomography and echocardiography was diagnosed constrictive pericarditis. Echocardiography confirmed the diagnosis of constrictive pericarditis, pericardial thickening and hyperechogenicity with abnormal myocardial wall motion, severe tricuspid valve insufficiency and moderate mitral valve insufficiency.MRI findings: irregular pericardial thickening with a maximum thickness of 4mm mostly effecting the right ventricle. Considering liver failure and, as a consequence, the presence of coagulopathy, it was decided to perform pericardectomy without the use of a heart-lung machine and without correction of valvular pathology. After the intervention, the patient retained severe tricuspid valve insufficiency and moderate mitral valve insufficiency, while the functional parameters of the liver progressively improved. Considering the unfavorable prognosis of the patient with tricuspid valve failure 3 weeks after pericardectomy, it was decided to perform mitral and tricuspid valve repair with the use of heart-lung machine, which was successfully done. The patient was discharged in satisfactory condition. At out-patient visit 42 days after the last surgical procedure the patient showed improvement of symptoms, normal sinus rhythm at examination, echocardiography found no signs of mitral valve failure and a minor residual tricuspid valve failure. Liver tests returned to normal on the 10-15th day.