Robotic-Assisted Total Pericardiectomy for Acute Relapsing Pericarditis: A Case Report

Acute, relapsing pericarditis is an uncommon potential complication of any cardiothoracic intervention. If medical management fails to mitigate recurrent symptoms, robotic total pericardiectomy can be performed as a definitive therapeutic option. A 33-year-old woman had severely symptomatic, persistent pericarditis, which began 3 weeks after pacemaker placement for tachy-brady syndrome. After failure of pharmacologic treatment, a robot-assisted total pericardiectomy was performed with a drastic improvement in symptoms. Considering that this case of pericarditis was inflammatory (nonconstrictive), a radical excisional approach to all the pericardium was undertaken in order to prevent relapse of symptoms. A bilateral endoscopic off-pump robot-assisted approach was used to completely and fully excise both the anterior and posterior pericardium. In conclusion, we present a case of acute relapsing pericarditis in a very symptomatic patient who failed medical therapy and underwent a robotic totally endoscopic radical pericardiectomy with excellent results. We believe that this technique allows for total pericardiectomy using the least invasive approach and should be considered in the management of this rare but potentially debilitating condition.