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Microwave Device-Assisted Pericardiectomy for Immunoglobulin G4-Related Constrictive Pericarditis: A Case Report
Yuriko Kiriya1, Keiichi Ishiwari1, Tomomitsu Takagi1
1Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Introduction:
Immunoglobulin G4 (IgG4)-related constrictive pericarditis (CP) is a rare condition with no standardized treatment. Surgical pericardiectomy is challenging due to dense adhesions and the risk of injury to the phrenic nerves and heart. Conventional energy devices carry risks of thermal damage. We report a novel application of a microwave ablation device (Acrosurg; Nikkiso, Tokyo, Japan) for radical pericardiectomy, highlighting its advantages in preventing nerve injury and ensuring hemostatic control.
Case Presentation:
A 79-year-old male patient with recurrent heart failure due to IgG4-related CP underwent off-pump radical pericardiectomy using a microwave ablation device (Acrosurg) and a positioner. The Acrosurg device enabled extensive and precise resection up to 1.5 cm from the phrenic nerves, achieving near total pericardiectomy without thermal injury, arrhythmia, or nerve paralysis. Postoperatively, cardiac index increased and central venous pressure normalized. The patient remained recurrence-free without steroids.
Conclusions:
This case demonstrated that the Acrosurg device allows safe and curative resection for CP, highlighting its utility as an innovative surgical tool.
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