Perioperative management of constrictive pericarditis with cardiac cirrhosis: A case report

The interactions between the heart and liver have been known for a long time, pericarditis constrictive could cause congestive hepatopathy via right-sided heart failure. Liver cirrhosis correlates with a high risk of mortality so perioperative management greatly influences outcomes. An Indonesian man, 50 years old, complained of breath shortness. The patient had a history of pulmonary tuberculosis and was declared cured 30 years ago. The patient began experiencing fatigue quickly 14 years ago, and 5 years ago, the patient was diagnosed with constrictive pericarditis. Currently, the patient has an increased jugular venous pressure of 9 cmH2O and abnormal laboratory indicators, including a platelet count of 121,000/μL, albumin count of 3.41 g/L, direct bilirubin count of 0.7 mg/dL, total bilirubin count of 1.4 mg/dL, and INR of 1.4. Echocardiography revealed left ventricle hypertropia, dysfunction diastolic, and right ventricle failure. Cardiac CT scan showed pericardial calcification. Abdominal ultrasound showed liver congestive and splenomegaly. Liver elastography showed severe fibrosis in the liver and stiffness in the spleen. The patient underwent pericardiectomy with a CTP score of 6 and a MELD of 12. The surgery was successful, and the complaint was reduced. The patient experienced an improvement in his condition and was able to carry out activities well after 2 years post-surgery. The patient has no contraindications to pericardiectomy, CTP class A (5–6) and MELD score <13.5 has a low risk of mortality. CTP and MELD scores predict life expectancy in post-surgery cardiac cirrhosis patients.