Constrictive pericarditis after coronary artery bypass surgery as a cause of unexplained dyspnea: A report of five cases

Abstract

Summary: Constrictive pencarditis after coronary artery bypass grafting (CABG) is rare and can present as unexplained dyspnea. We report five consecutive cases of post-CABG constrictive pericarditis seen within a period of I7 months at our institution. All patients presented with heart failure ofunknown etiology within a period of 8-84 months after surgery. During the initial post-CABG period, two patients had developed postcardiotomy syndrome that was successfully treated with steroids. They were all assessed noninvasively and invasively. In all patients, the diagnosis of constriction was initially suspected clinically ( symptoms, high jugular venous pressure with deep "X" and "Y" descents, pericardial knock). Echocardiography showed transmitral flow typical of constriction in all patients and hepatic venous flow in two. Two patients showed rapid left ventricular relaxation. In all patient s, hemodynamic assessment showed diastolic equalization of pressures in all chambers, "W' shape waveform in right atrial pressure, and "dip and plateau" configuration in right and left ventricular pressure waveforms. Diagnosis was confirmed surgically in four patients who were subjected to pericardiectomy-pericardial stripping (three survived. one died). One patient rehsed surgery. We conclude that constrictive pericarditis, although rare, should be suspected in every case of unexplained dyspnea post CABG. It can appear early or late after surgery, and clinical examination plays an important role in its early recognition. It requires a full noninvasive and invasive assessment in case of clinical suspicion.

Constrictive pericarditis following surgical repair of a peritoneopericardial diaphragmatic hernia in a cat

“…16,17 The pathophysiology of post-surgery CP is unclear and is likely multifactorial as it has been hypothesized that pooling of blood into the pericardial cavity may represent a stimulus for ongoing pericardial irritation and development of tight adhesions. 17,18 Pleural effusion is a rare initial finding and post operative complication of PPDH repair in cats, and in some cases persists after surgical repair, as in the cat here. 14,15 The pathophysiology of pleural effusion development in cats with PPDH has not be identified, but in a dog with PPDH and chylothorax it was postulated to be secondary to compression of the right heart by the abdominal viscera; 19 this was the initial hypothesis for the development of pleural effusion in the cat here.…”

“…16,17 The pathophysiology of post-surgery CP is unclear and is likely multifactorial as it has been hypothesized that pooling of blood into the pericardial cavity may represent a stimulus for ongoing pericardial irritation and development of tight adhesions. 17,18…”

Early-onset post-cardiotomy severe constrictive pericarditis: a case report

“… 5 The presence of post-pericardiotomy syndrome has been implicated as a risk factor for the development of post-cardiotomy CP. 6 …”

A modern cause of an old disease. Constrictive pericarditis after percutaneous coronary intervention: A case report

“…Although the actual cause is unknown, several factors are suspected, including surgical trauma, hemopericardium, infection, postpericardiotomy inflammation, cold injury, various pericardial irritants (povidone-iodine, antibiotics) and air desiccation. The onset of symptoms has been reported to be from two weeks to 30 years after cardiac surgery (3,4).…”