[Constrictive pericarditis complicated with hepatic coma--a case report]

A 39-year-old man with pedal edema and icterus was admitted to our hospital. Laboratory findings revealed hyperbilirubinemia. Echocardiography and chest CT revealed the calcified mass front of the right ventricle. As cardiac catheterization showed dip and plateau in right ventricle, the diagnosis of constrictive pericarditis was established. Considering his condition and bleeding tendency with hepatic failure, plasma exchange was done for three days before operation. As the patient's condition deteriorated with hepatic coma, pericardiectomy was performed. The median sternotomy approach without cardiopulmonary bypass was selected. The calcified mass was removed, and the thickened pericardium was excised. Postoperative hemodynamic findings were improved, and the serum bilirubin returned to normal. In conclusion even in this case with severe hepatic failure due to constrictive pericarditis, surgical treatment should have be considered.