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Cystic mass formation in constrictive pericarditis and epicarditis after open-heart surgery

Yuki Okamoto1, Masahiko Matsumoto, Hidenori Inoue

  • 1Second Department of Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan. yamanashimedical@yahoo.co.jp

Interactive Cardiovascular and Thoracic Surgery
|February 19, 2009
PubMed

Insights

This case study details constrictive pericarditis and epicarditis diagnosed late after heart surgery. Imaging was inconclusive, but surgery revealed a cystic mass causing heart compression, confirmed by pathology.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Pathology

Background:

  • A 74-year-old male with prior coronary artery bypass grafting presented with heart failure.
  • The patient developed symptoms late after open-heart surgery.

Observation:

  • Transthoracic echocardiography, CT, and MRI revealed a non-enhancing cystic lesion compressing the right ventricle and main pulmonary artery.
  • Pericardial hypertrophy was not clearly visualized on initial imaging.
  • Surgical intervention was planned for diagnosis and decompression.

Findings:

  • Intraoperative findings included a cystic mass encased in thickened pericardial and epicardial fibrous tissue, containing clear, yellowish fluid.
  • A waffle procedure was performed without cardiopulmonary bypass.
  • Histopathology of the excised epicardium showed neovascularization, minimal inflammation, and thickened hyaline connective tissue, confirming constrictive pericarditis and epicarditis.

Implications:

  • This case highlights a rare presentation of constrictive pericarditis and epicarditis mimicking a benign cystic lesion post-cardiac surgery.
  • Diagnostic challenges posed by atypical imaging findings in late post-operative complications are emphasized.
  • Successful management involved surgical excision and pericardial remodeling, offering insights into treating such complex cases.

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