The case report describes the hospitalization of a 50-year-old man who underwent surgery for a constrictive pericarditis at a younger age. Current CT and ultrasonographic findings confirmed the recurrence of this disease. Partial pericardectomy was performed with the release of the left ventricular diaphragm wall in particular. The postoperative period was complicated by ventricular fibrillation with high speed response of chambers. After successful cardioversion, the patient was released to outpatient care on the seventh postoperative day.
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Anamnesis:
50-year-old man
PA: persistent atrial fibrillation, stroke 7 years ago, surgery because of constrictive pericarditis 30 years ago, splenectomy 30 years ago
FA: no hereditary diagnosis
PA: Eliquis 5mg 1-0-1 tbl (5 days does not use), Concor COR 2,5mg 1-0-0 tbl, Tritace 1,25mg 1-0-0 tbl, Furon 40mg 1-0-0 tbl, Atoris 20mg 0-0-1 tbl, Lexaurin 3mg 1/2-0-1 tbl.
AA: sine
DA: negative
SA: a partial disability pensioner
AD: Patient admitted to the cardiology department for suspected unstable angina pectoris. Coronarography do not validate IHD. Echocardiography shows calcification of pericardium with good left ventricle ejection fraction without segmental kinetics disorder. ECHO also showed dilatation of LA and no valve disorder. Computer tomography also showed calcification of pericardium. Patient admitted to heart surgery department for surgery.
Laboratoty results:
Laboratory: normal
Imaging methods:
ECHO: Ao sinus= 34 mm, LA diameter= 50 mm, IVS= 10 mm, LVEDD= 49 mm, LVESD= 37 mm, LA: LAV= 96 ml, LAVI= 40 ml/m2. Calcification of mitral anulus, without regurgitation; LVEF(3D)= 56 %, LVEDV= 118 ml, LVESV= 51 ml; IAS: without defect.
Conclusion: status after surgery because of constrictive pericarditis, calcification of basal segment presented. Excessive calcification of mitral annulus. Left ventricle is not dilated, LVEF=56%.
Coronarography: ACS: without stenosis; LAD: without stenosis; RCX: without stenosis; ACD: without stenosis; Conclusion: normal finding.
CT: excessive calcification of pericardium – near to left ventricle and left AV groove. Diameter of calcification is 4.7cm. Dilated both atriums and ventricles of heart. Dilated VCI and VCS. Left side pleura calcifications.
Diagnoses:
Constrictive pericarditis with unknown etiology
Atrial fibrillation
Stroke in history
Splenectomy in history
Dyspepsia
Therapy and conclusion:
Treatment strategy:
Partial excision of pericardium is indicated.
Surgery procedure:
Partial excision of pericardium.
Postoperative course:
Postoperative course complicated by AF with tachycardia. EKV administrated on 6th postoperative day. On 7th postoperative day released to outpatient care.
Abbreviations:
ACD – right coronary artery; ACS – left coronary artery; AF – atrial fibrillation; AV – atrioventricular; CT – computer tomography; ECHO – echocardiography; EKV – electro cardioversion; IAS – interatrial septum; IHD – ischemic heart disease; IVS – interventricular septum; LA – left atrium; LAD: left anterior descending coronary artery; LAV – left atrium volume; LAVI – indexed left atrium volume; LV – left ventricle; LVEDD – left ventricle end diastolic diameter; LVEDV – left ventricle end diastolic volume; LVEF – left ventricle ejection fraction; LVESD – left ventricle end systolic diameter; LVESV – left ventricle end systolic volume; NCMP – stroke; RA – right atrium; RCX – circumflex artery; RIA – left anterior descending artery; RTG – X ray picture; SR – sinus rhythm; TEE – trans-esophageal echocardiography; VCI – vena cava inferior; VCS – vena cava superior
Authors declare the case report will not be published in any national or international publications.
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citation: Tomáš Toporcer: Constrictive pericarditis, reoperation. Multimedia support in the education of clinical and health care disciplines :: Portal of Pavol Jozef Šafárik University in Košice Faculty of Medicine [online] , [cit. 21. 11. 2024]. Available from WWW: https://portal.lf.upjs.sk/articles.php?aid=301. ISSN 1337-7000.