Reoperation for calcific constrictive pericarditis 43 years after pericardiectomy

Area of Science:

• Cardiology
• Thoracic Surgery
• Medical Case Reports

Background:

• Pericardiectomy is a surgical procedure to remove part or all of the pericardium.
• Calcific pericarditis can lead to constrictive physiology, impairing cardiac function.
• Recurrent constrictive pericarditis after initial surgery presents unique clinical challenges.

Observation:

• A 63-year-old male presented with a 1-year history of progressive right heart failure.
• Symptoms arose 43 years after an initial pericardiectomy in 1960.
• Imaging revealed calcification of residual pericardium and sternal compression from pectus excavatum encasing the heart.

Findings:

• The recurrent constriction was attributed to calcification of the posteroinferior pericardium and sternal deformity.
• The patient underwent a second total pericardiectomy via median sternotomy with cardiopulmonary bypass.
• Histopathology confirmed extensive pericardial calcification.

Implications:

• This case highlights the potential for late-onset, severe calcific pericarditis following initial pericardiectomy.
• Surgical management of recurrent constrictive pericarditis, even decades later, can be effective.
• Pectus excavatum can exacerbate cardiac compression in the presence of pericardial calcification.