Abstract
Background Pericardiectomy is the standard treatment in
patients who have constrictive pericarditis and persistent symptoms. A
possible surgical complication is right ventricle (RV) failure. We
report a case of a 44-year-old man who developed RV failure after
pericardiectomy.
Case report A 41-year-old man with no medical history was
referred to our hospital due to progressive dyspnea associated with
edema of the lower limbs, and significant weight loss (30 Kg) for 5
months. Transthoracic echocardiography (TTE) revealed significant
pericardial thickening and mild pericardial effusion with normal RV
function. Chest computed tomography (CT) showed moderate bilateral
pleural effusion. The patient underwent pericardiectomy and bilateral
pleural drainage. Morphological exam showed tuberculosis granulomas with
caseous necrosis and anti-tuberculosis medication was started.
Postoperative TTEs showed normal RV function and mild pericardial
thickening. Patient was discharged home after successful postoperative
recovery. Two weeks later, the patient was admitted to the emergency
department with dyspnea and hypoxemia. TTE revealed RV systolic
dysfunction. Diuretics and inotropic therapy were started. Chest CT
showed recurrence of moderate pleural effusion, this time loculated,
with restrictive atelectasis of the adjacent lung parenchyma. Patient
underwent lung decortication after confirmation of tuberculous pleural
empyema. TTE showed a decreased RV chamber size with improved RV
systolic function, the patient evolved with clinical improvement and was
discharged 30 days after admission.
Conclusions RV dysfunction after pericardiectomy is a
potentially fatal event, and requires diuretics, and hemodynamic
support. We emphasize the need for a thorough clinical evaluation of
patients undergoing pericardiectomy for constrictive pericarditis in
order to minimize unfavorable outcomes.
Key words Right ventricular dysfunction; Constrictive
pericarditis; Pericardiectomy; Low cardiac
output; Tuberculous pericarditis