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Surgical treatment of chronic aortic dissection with liver dysfunction due to constrictive pericarditis caused by

Akie Shimada1, Taira Yamamoto1, Shizuyuki Dohi1

  • 1Department of Cardiovascular Surgery, Juntendo Nerima Hospital, Takanodai 3-1-10, Nerima-Ku, Tokyo 177-8521, Japan.

European Heart Journal. Case Reports
|September 17, 2024
PubMed

Insights

Severe liver failure and ascites in a 72-year-old man were caused by constrictive pericarditis and aortic dissection, identified as immunoglobulin G4-related disease (IgG4-RD). Successful aortic surgery was performed, highlighting the importance of collaborative care.

Area of Science:

  • Cardiology
  • Gastroenterology
  • Immunology

Background:

  • Ascites and liver failure can be manifestations of cardiac conditions like constrictive pericarditis and aortic dissection.
  • Immunoglobulin G4-related disease (IgG4-RD) can present with diverse systemic manifestations, including cardiovascular and hepatic involvement.

Observation:

  • A 72-year-old male presented with ascites and scrotal edema, initially managed for liver issues.
  • Computed tomography revealed DeBakey type II aortic dissection, pericardial thickening, and right ventricular dysfunction.
  • Histopathological analysis showed IgG4-related disease (IgG4-RD) as the underlying cause, confirmed by response to steroid treatment.

Findings:

  • The patient underwent successful ascending aortic replacement.
  • IgG4 staining of the aortic wall indicated a ratio of 35% IgG4/IgG positive cells.
  • Despite initial suspicion of IgG4-related aortitis, the diagnosis of IgG4-RD was established based on clinical and laboratory findings.

Implications:

  • This case underscores the critical role of cardiac evaluation in patients presenting with ascites and liver dysfunction.
  • Early diagnosis and management of IgG4-RD are crucial for preventing severe systemic complications.
  • Multidisciplinary collaboration is essential for managing complex cases involving multiple organ systems.
Abstract

Keywords:
AscitesCase reportChronic aortic dissectionIgG4-related diseasesLiver cirrhosisSystolic pericarditis

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