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Perioperative management of constrictive pericarditis with cardiac cirrhosis: A case report

Yudha Klahan Nugraha1, Ummi Maimunah2

  • 1Study Program of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.

International Journal of Surgery Case Reports
|June 7, 2024
PubMed

Insights

Constrictive pericarditis can lead to liver issues. Successful pericardiectomy improved a patient's condition, with Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores predicting outcomes.

Area of Science:

  • Cardiology
  • Hepatology
  • Cardiovascular Surgery

Background:

  • Constrictive pericarditis can cause congestive hepatopathy due to right-sided heart failure.
  • Liver cirrhosis presents a significant mortality risk, emphasizing the importance of perioperative management.

Observation:

  • A 50-year-old man with a history of tuberculosis presented with shortness of breath and fatigue.
  • Diagnosed with constrictive pericarditis, he exhibited elevated jugular venous pressure, abnormal liver function tests, and echocardiographic/CT findings of cardiac dysfunction and pericardial calcification.
  • Abdominal imaging revealed liver congestion and splenomegaly, with elastography indicating severe liver fibrosis.

Findings:

  • The patient underwent pericardiectomy with a Child-Turcotte-Pugh (CTP) score of 6 and Model for End-Stage Liver Disease (MELD) score of 12.
  • Post-surgery, the patient experienced symptom reduction and significant functional improvement over two years.
  • The patient had no contraindications for pericardiectomy, with CTP class A and MELD score <13.5 indicating a low perioperative mortality risk.

Implications:

  • Pericardiectomy is a viable treatment for constrictive pericarditis leading to liver dysfunction.
  • CTP and MELD scores are crucial for predicting life expectancy in patients with post-cardiac cirrhosis undergoing surgery.
Abstract

Keywords:
Cardiac cirrhosisConstrictive pericarditisPericardiectomyPerioperative management

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