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