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A Patient with Extremely Severe Constrictive Pericarditis Underwent Emergency Pericardiectomy Without Cardiopulmonary Bypass

Received: 23 March 2023     Accepted: 10 April 2023     Published: 15 April 2023
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Abstract

We report a case of a 58-year-old man admitted to hospital with severe constrictive pericarditis. An emergency pericardiectomy was planned due to the patient's orthopnea associated with hemodynamic instability. The patient performed pericardiectomy without cardiopulmonary bypass. The patient was found to be orthopnea and began to experience disturbance of consciousness after entering the operating room. Non-invasive blood pressure was 100/54 mmHg, accompanied by atrial fibrillation, the ventricular rate was 158 beats/min, and arterial oxygen saturation was 90% with air inhalation. After intubation, the ventricular rate rose to 187 beats/min, the blood pressure dropped to 65/45 mmHg, and vasopressors were urgently administered to maintain circulatory stability. At the same time, the internal jugular vein cannula was placed ultrasound-guided. During the operation, the central venous pressure (CVP) increased to 41.2 cmH2O, and cerebral oxygen saturation dropped to 47.6%. Although the patient with severe constrictive pericarditis, we still performed pericardiectomy without cardiopulmonary bypass. The operation time was about 3 hours, and the patient was successfully transferred to the Intensive Care Unit (ICU) to continue monitoring and treatment, and the tracheal intubation was removed 48 hours after the operation and he was discharged 19 days after the operation. Real-time transesophageal echocardiography (TEE) monitoring played a crucial role in intraoperative management.

Published in International Journal of Anesthesia and Clinical Medicine (Volume 11, Issue 1)
DOI 10.11648/j.ijacm.20231101.17
Page(s) 32-34
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Constrictive Pericarditis, Disturbance of Consciousness, Pericardiectomy, Transesophageal Echocardiography

References
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[3] Di Lazzaro D, Di Bella I, Pasquino S, Berti V, Da Col U. Pericardiectomy for constrictive pericarditis. Multimed Man Cardiothorac Surg. 2020 Dec 22; 2020.
[4] Chang S A, Oh J K. Constrictive Pericarditis: A Medical or Surgical Disease? [J]. Journal of cardiovascular imaging, 2019, 27 (3): 178-186. DOI: 10.4250/jcvi.2019.27.e28.
[5] Zhu P, Mai M, Wu R, et al. Pericardiectomy for constrictive pericarditis: single-center experience in China [J]. Journal of cardiothoracic surgery, 2015, 10: 1-5.
[6] Sultan F A T, Tariq M U. Clinical features, management and outcome of patients with constrictive pericarditis–Experience from a third world country [J]. Journal of the Saudi Heart Association, 2018, 30 (1): 9-13.
[7] Schwefer M, Aschenbach R, Heidemann J, et al. Constrictive pericarditis, still a diagnostic challenge: comprehensive review of clinical management [J]. European journal of cardio-thoracic surgery, 2009, 36 (3): 502-510.
[8] Sellors T H. Constrictive pericarditis [J]. Journal of British Surgery, 1946, 33 (131): 215-230.
[9] Brauer L. Die Kardiolysis und ihre indikationen [J]. Arch Klin Chir, 1903, 71: 258.
[10] Murashita T, Schaff H V, Daly R C, et al. Experience with pericardiectomy for constrictive pericarditis over eight decades [J]. The Annals of thoracic surgery, 2017, 104 (3): 742-750.
[11] Busch C, Penov K, Amorim P A, et al. Risk factors for mortality after pericardiectomy for chronic constrictive pericarditis in a large single-centre cohort [J]. European Journal of Cardio-Thoracic Surgery, 2015, 48 (6): e110-e116.
[12] Gatti G, Fiore A, Ternacle J, et al. Pericardiectomy for constrictive pericarditis: a risk factor analysis for early and late failure [J]. Heart and Vessels, 2020, 35: 92-103.
[13] Rupprecht L, Putz C, Flörchinger B, et al. Pericardiectomy for constrictive pericarditis: an institution's 21 years experience [J]. The Thoracic and cardiovascular surgeon, 2018, 66 (08): 645-650.
[14] Karima T, Nesrine BZ, Hatem L, Skander BO, Raouf D, Selim C. Constrictive pericarditis: 21 years' experience and review of literature. Pan Afr Med J. 2021 Feb 8; 38: 141.
[15] Tokuda Y, Miyata H, Motomura N, et al. Outcome of pericardiectomy for constrictive pericarditis in Japan: a nationwide outcome study [J]. The Annals of thoracic surgery, 2013, 96 (2): 571-576.
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  • APA Style

    Danfeng Xu, Xuejie Li. (2023). A Patient with Extremely Severe Constrictive Pericarditis Underwent Emergency Pericardiectomy Without Cardiopulmonary Bypass. International Journal of Anesthesia and Clinical Medicine, 11(1), 32-34. https://doi.org/10.11648/j.ijacm.20231101.17

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    ACS Style

    Danfeng Xu; Xuejie Li. A Patient with Extremely Severe Constrictive Pericarditis Underwent Emergency Pericardiectomy Without Cardiopulmonary Bypass. Int. J. Anesth. Clin. Med. 2023, 11(1), 32-34. doi: 10.11648/j.ijacm.20231101.17

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    AMA Style

    Danfeng Xu, Xuejie Li. A Patient with Extremely Severe Constrictive Pericarditis Underwent Emergency Pericardiectomy Without Cardiopulmonary Bypass. Int J Anesth Clin Med. 2023;11(1):32-34. doi: 10.11648/j.ijacm.20231101.17

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  • @article{10.11648/j.ijacm.20231101.17,
      author = {Danfeng Xu and Xuejie Li},
      title = {A Patient with Extremely Severe Constrictive Pericarditis Underwent Emergency Pericardiectomy Without Cardiopulmonary Bypass},
      journal = {International Journal of Anesthesia and Clinical Medicine},
      volume = {11},
      number = {1},
      pages = {32-34},
      doi = {10.11648/j.ijacm.20231101.17},
      url = {https://doi.org/10.11648/j.ijacm.20231101.17},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20231101.17},
      abstract = {We report a case of a 58-year-old man admitted to hospital with severe constrictive pericarditis. An emergency pericardiectomy was planned due to the patient's orthopnea associated with hemodynamic instability. The patient performed pericardiectomy without cardiopulmonary bypass. The patient was found to be orthopnea and began to experience disturbance of consciousness after entering the operating room. Non-invasive blood pressure was 100/54 mmHg, accompanied by atrial fibrillation, the ventricular rate was 158 beats/min, and arterial oxygen saturation was 90% with air inhalation. After intubation, the ventricular rate rose to 187 beats/min, the blood pressure dropped to 65/45 mmHg, and vasopressors were urgently administered to maintain circulatory stability. At the same time, the internal jugular vein cannula was placed ultrasound-guided. During the operation, the central venous pressure (CVP) increased to 41.2 cmH2O, and cerebral oxygen saturation dropped to 47.6%. Although the patient with severe constrictive pericarditis, we still performed pericardiectomy without cardiopulmonary bypass. The operation time was about 3 hours, and the patient was successfully transferred to the Intensive Care Unit (ICU) to continue monitoring and treatment, and the tracheal intubation was removed 48 hours after the operation and he was discharged 19 days after the operation. Real-time transesophageal echocardiography (TEE) monitoring played a crucial role in intraoperative management.},
     year = {2023}
    }
    

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    AU  - Danfeng Xu
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    PB  - Science Publishing Group
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    AB  - We report a case of a 58-year-old man admitted to hospital with severe constrictive pericarditis. An emergency pericardiectomy was planned due to the patient's orthopnea associated with hemodynamic instability. The patient performed pericardiectomy without cardiopulmonary bypass. The patient was found to be orthopnea and began to experience disturbance of consciousness after entering the operating room. Non-invasive blood pressure was 100/54 mmHg, accompanied by atrial fibrillation, the ventricular rate was 158 beats/min, and arterial oxygen saturation was 90% with air inhalation. After intubation, the ventricular rate rose to 187 beats/min, the blood pressure dropped to 65/45 mmHg, and vasopressors were urgently administered to maintain circulatory stability. At the same time, the internal jugular vein cannula was placed ultrasound-guided. During the operation, the central venous pressure (CVP) increased to 41.2 cmH2O, and cerebral oxygen saturation dropped to 47.6%. Although the patient with severe constrictive pericarditis, we still performed pericardiectomy without cardiopulmonary bypass. The operation time was about 3 hours, and the patient was successfully transferred to the Intensive Care Unit (ICU) to continue monitoring and treatment, and the tracheal intubation was removed 48 hours after the operation and he was discharged 19 days after the operation. Real-time transesophageal echocardiography (TEE) monitoring played a crucial role in intraoperative management.
    VL  - 11
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Author Information
  • Department of Anesthesiology, West China Hospital, Sichuan University and the Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China

  • Department of Anesthesiology, West China Hospital, Sichuan University and the Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China

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