A Recurrent Case of Constrictive Pericarditis after Pericardiectomy Using ePTFE Pericardial Substitution

Naoya Sakoda＊	Hideo Yoshida＊	Takuya Kawabata＊
Munehiro Saiki＊＊	Yasuhumi Fujita＊	Keiji Yunoki＊＊
Kunikazu Hisamochi＊

（Department of Cardiovascular Surgery＊, and Department of Endovascular Treatment for Structure Heart and Aortic Disease＊＊, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan）

A 67-year-old man developed the recurrence of postoperative constrictive pericarditis. He had two operation histories:the one was CABG for old myocardial infarction and the other was pericardiectomy for postoperative pericarditis at 57 and 59 years old respectively. Both operations were performed in our hospital. We used an ePTFE sheet for covering the heart in the pericardiectomy. The course post operation was good, but eight years after the pericardiectomy, he had abdominal distension and leg edema. Detailed studies revealed a recurrence of constrictive pericarditis, and reoperation was performed. The re-operative finding showed thickened sclerotic tissues on both sides of an ePTFE sheet which was applied to the cardiac surface during the previous surgery. No abnormal tissue was detected where the ePTFE sheet was not applied. The ePTFE sheet and the sclerotic tissues were removed under cardiopulmonary bypass support, and then diastolic dysfunction improved dramatically. His chest was closed without applying an ePTFE sheet. His post-operative course was uneventful and he was discharged on the 20th postoperative day. The ePTFE sheet was highly suspected as a cause of the recurrent constrictive pericarditis. An ePTFE sheet-induced constrictive pericarditis should be considered as one of the postoperative complications even in the mid and long-term period. The ePTFE sheet is useful for preventing heart or vascular injury when we perform resternotomy, but in rare cases, there is some possibility of association with a risk of pericarditis.

 

Jpn. J. Cardiovasc. Surg. 50:252-255（2021）

Keywords：constrictive pericarditis;ePTFE;recurrence;pericardiectomy;diastolic disfunction