Constrictive Pericarditis with Repeated Hepatic Encephalopathy Associated with Hepatic Cirrhosis:A Case Report

Shuji Moriyama＊

Masahiko Hara＊

Yasushi Kaneko＊

（Department of Cardiovascular Surgery, Kumamoto Rosai Hospital＊, Yatsushiro, Japan）

We report a case of constrictive pericarditis with repeated hepatic encephalopathy due to hepatic cirrhosis. A 69-year-old man with exertional dyspnea and leg edema was admitted to our hospital. He had been admitted to our hospital thrice in the past 1 year owing to hepatic encephalopathy. He had hyperammonemia, hyperbilirubinemia, and renal dysfunction. Computed tomography revealed a thick pericardium with calcification and bilateral pleural effusion, and transthoracic echocardiography revealed abnormal early diastolic septal movement and right ventricular restriction. Further, cardiac catheterization identified increased central venous（36mmHg）and a mean pulmonary arterial of 53mmHg and a dip-and-plateau right ventricular pressure curve. We diagnosed constrictive pericarditis. Accordingly, pericardiectomy without extracorporeal circulation was performed. A hypertrophic calcified pericardium was found to be expanded throughout the right atrium to the free wall of the right ventricle. Postoperatively, the patient’s exertional dyspnea and leg edema resolved, and he recovered without any complications.
　　

Jpn. J. Cardiovasc. Surg. 48:173-178（2019）

Keywords：constrictive pericarditis;hepatic encephalopathy;hepatic cirrhosis