Simultaneous pericardiectomy and coronary artery bypass grafting reduced liver stiffness from 19.7 kPa to 5.7 kPa at 19 months in a patient with constrictive pericarditis and three-vessel disease.
Case Report (n=1)
No
Does simultaneous pericardiectomy and CABG improve liver stiffness and cardiac function in a patient with constrictive pericarditis and three-vessel coronary artery disease?
Simultaneous pericardiectomy and CABG can lead to marked improvement in liver stiffness and overall cardiac function in patients with constrictive pericarditis and severe coronary artery disease.
Background Constrictive pericarditis (CP) is characterized by the thickening and scarring of the pericardium, often leading to impaired cardiac function. CP can have systemic effects, including congestive hepatopathy, which may increase liver stiffness and, in chronic cases, contribute to fibrosis. A pericardiectomy is the best choice of treatment in these patients and can alleviate cardiac dysfunction, potentially improving associated systemic conditions; however, concomitant liver dysfunction and three-vessel disease can make pericardiectomy a challenging surgery in these patients. Also, marked improvement in liver stiffness after surgical relief of constrictive physiology is rarely documented in the literature. Case presentation A 62-year-old man with a history of coronary artery disease (CAD) presented with abdominal pain and distention, edema, unintentional weight loss, and dyspnea. Transient elastography showed markedly elevated liver stiffness compatible with advanced fibrosis, although congestion-related overestimation could not be excluded. Due to concern for cardiac etiology, cardiac magnetic resonance imaging (CMR) was performed, which indicated constrictive pericarditis (CP). Also, the patient was a candidate for coronary artery bypass grafting (CABG) due to three-vessel disease shown in his recent angiography. The patient underwent simultaneous pericardiectomy and coronary CABG with subsequent improvement of his symptoms. Follow-up at six months showed normal heart function and reduced liver size, and follow-up transient elastography 19 months later showed marked reduction in liver stiffness. Conclusions This case highlights that severe liver stiffness abnormalities in CP may substantially improve after surgical relief of constrictive physiology. The concomitant performance of CABG likely contributed to improved overall cardiac function and systemic hemodynamics, further facilitating liver recovery. Early recognition using multimodality imaging, including CMR, and timely intervention in patients with CP and liver stiffness abnormalities may facilitate hepatic recovery and prevent persistent end-organ dysfunction.
Tabesh et al. (2026) conducted a case report in Constrictive pericarditis and coronary artery disease (n=1). Simultaneous pericardiectomy and coronary artery bypass grafting (CABG) was evaluated on Liver stiffness measured by transient elastography. Simultaneous pericardiectomy and coronary artery bypass grafting reduced liver stiffness from 19.7 kPa to 5.7 kPa at 19 months in a patient with constrictive pericarditis and three-vessel disease.