Constrictive Pericarditis as a Long-term Undetermined Etiology of Ascites and Edema

Kamio, Takahiro; Hiraoka, Eiji; Obunai, Kotaro; Watanabe, Hiroyuki

doi:10.2169/internalmedicine.9455-17

Cited by 4 publications

(2 citation statements)

References 15 publications

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“…Constrictive pericarditis: In the context of patients with ESLD awaiting LT, constrictive pericarditis occurs as an etiology of chronic liver disease whereby longstanding hepatic congestion can lead to cardiac cirrhosis. A high degree of clinical suspicion is required as symptoms of constrictive pericarditis such as ascites, hepatomegaly and peripheral edema are often misdiagnosed as primary chronic liver disease[ 121 ]. TTE with doppler is the initial recommended test which may reveal characteristics suggestive of constrictive pericarditis such as ventricular septal shift with respiration, variation in mitral annular inflow velocity, a thickened pericardium, and rapid early diastolic filling[ 122 ].…”

Section: Clinical Entitiesmentioning

confidence: 99%

Cardiac risk stratification of the liver transplant candidate: A comprehensive review

Nagraj¹,

Peppas²,

Guerrero³

et al. 2022

WJT

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Cardiovascular diseases (CVD) form a principal consideration in patients with end-stage liver disease (ESLD) undergoing evaluation for liver transplant (LT) with prognostic implications in the peri- and post-transplant periods. As the predominant etiology of ESLD continues to evolve, addressing CVD in these patients has become increasingly relevant. Likewise, as the number of LTs increase by the year, the proportion of older adults on the waiting list with competing comorbidities increase, and the demographics of LT candidates evolve with parallel increases in their CVD risk profiles. The primary goal of cardiac risk assessment is to preemptively reduce the risk of cardiovascular morbidity and mortality that may arise from hemodynamic stress in the peri- and post-transplant periods. The complex hemodynamics shared by ESLD patients in the pre-transplant period with adverse cardiovascular events occurring in only some of these recipients continue to challenge currently available guidelines and their uniform applicability. This review focusses on cardiac assessment of LT candidates in a stepwise manner with special emphasis on preoperative patient optimization. We hope that this will reinforce the importance of cardiovascular optimization prior to LT, prevent futile LT in those with advanced CVD beyond the stage of optimization, and thereby use the finite resources prudently.

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Section: Clinical Entitiesmentioning

confidence: 99%

Cardiac risk stratification of the liver transplant candidate: A comprehensive review

Nagraj¹,

Peppas²,

Guerrero³

et al. 2022

WJT

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“…A RNMC, em comparação com a TC, pode avaliar com precisão as consequências hemodinâmicas da constrição pericárdica, pericárdio minimamente espessado mostrando realce das camadas pericárdicas no LCE 8 . As alterações sugestivas de PC são VD alongado e estreito, movimentação anormal do septo interventricular com forma sigmoide, congestão da veia cava inferior, interrupção abrupta do enchimento diastólico, aumento do átrio direito, inflamação e espessamento pericárdico [15][16][17] , corroborando com os achados da RNMC realizada pela paciente do caso descrito.…”

Section: Relato Do Casounclassified

Pericardite constritiva como causa de hepatopatia crônica: uma etiologia a ser lembrada - relato de caso / Constritive pericarditis as a cause of chronic hepatopathy: an etiology to be remembered - case report

Souza¹,

Nobre²,

Júnior³

et al. 2022

Braz. J. Hea. Rev.

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INTRODUÇÃO: A Pericardite Constritiva (PC) é uma causa de Insuficiência Cardíaca (IC) Restritiva onde ocorre comprometimento do enchimento cardíaco decorrente do processo cicatricial de pericardite prévia que torna o pericárdio espessado, calcificado, aderido e inelástico. Deve ser considerada no diagnóstico diferencial de insuficiência cardíaca de etiologia indefinida especialmente nos casos em que a fração de ejeção do ventrículo esquerdo (VE) é preservada. É com frequência confundida com outras patologias, sendo muitas vezes diagnosticada erroneamente como doença hepática crônica. OBJETIVO: relatar o caso de uma paciente em investigação de hepatopatia crônica e posteriormente foi finalmente diagnosticada com PC. CASO CLÍNICO: Paciente feminina, 49 anos, sem antecedentes pessoais prévios. Negava etilismo e tabagismo. Estava em investigação de ascite, edema de membros inferiores e dispneia aos esforços habituais. Ao exame físico apresentava turgência jugular e edema de membros inferiores além de ascite. Apresentou ecografia normal no início da investigação,

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Constrictive pericarditis as a cause of refractory ascites after liver transplantation: A case report

Bezjak¹,

Kocman²,

Jadrijević³

et al. 2019

WJCC

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BACKGROUNDRefractory ascites is a rare complication following orthotopic liver transplantation (OLT). The broad spectrum of differential diagnosis often leads to delay in diagnosis. Therapy depends on recognition and treatment of the underlying cause. Constrictive pericarditis is a condition characterized by clinical signs of right-sided heart failure. In the advanced stages of the disease, hepatic congestion leads to formation of ascites. In patients after OLT, cardiac etiology of ascites is easily overlooked and it requires a high degree of clinical suspicion.CASE SUMMARYWe report a case of a 55-year-old man who presented with a refractory ascites three months after liver transplantation for alcoholic cirrhosis. Prior to transplantation the patient had a minimal amount of ascites. The transplant procedure and the early postoperative course were uneventful. Standard post-transplant work up failed to reveal any typical cause of refractory post-transplant ascites. The function of the graft was good. Apart from atrial fibrillation, cardiac status was normal. Eighteen months post transplantation the patient developed dyspnea and severe fatigue with peripheral edema. Ascites was still prominent. The presenting signs of right-sided heart failure were highly suggestive of cardiac etiology. Diagnostic paracentesis was suggestive of cardiac ascites, and further cardiac evaluation showed typical signs of constrictive pericarditis. Pericardiectomy was performed followed by complete resolution of ascites. On the follow-up the patient remained symptom-free with no signs of recurrent ascites and with normal function of the liver graft.CONCLUSIONRefractory ascites following liver transplantation is a rare complication with many possible causes. Broad differential diagnosis needs to be considered.

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Constrictive Pericarditis as a Long-term Undetermined Etiology of Ascites and Edema

Cited by 4 publications

References 15 publications

Cardiac risk stratification of the liver transplant candidate: A comprehensive review

Cardiac risk stratification of the liver transplant candidate: A comprehensive review

Pericardite constritiva como causa de hepatopatia crônica: uma etiologia a ser lembrada - relato de caso / Constritive pericarditis as a cause of chronic hepatopathy: an etiology to be remembered - case report

Constrictive pericarditis as a cause of refractory ascites after liver transplantation: A case report

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