Key result
Pericardiectomy reduces central venous pressure by ~7 mmHg and instantaneously improves right ventricular motion.
Case Report (n=1)
No
This case report highlights that constrictive pericarditis can occur as a rare complication after minimally invasive cardiac surgery and can be successfully treated with pericardiectomy.
Constrictive pericarditis may occur after minimally invasive cardiac surgery; leaves open whether incidence differs from sternotomy.
症例は68歳，男性．僧帽弁狭窄症，三尖弁閉鎖不全症，心房細動に対し僧帽弁置換術，三尖弁形成術，MAZE手術を内視鏡下右小開胸で施行した．特記すべき合併症なく第7病日に退院となったが，退院後約2カ月が経過した頃より心嚢水貯留と右心不全症状を認め，利尿剤やステロイドなど内服加療を行ったがコントロール困難で入院を繰り返した．CT検査や心臓超音波検査では特異的な所見は認めなかったが，心臓カテーテル検査でdip and plateau patternを認めたため収縮性心膜炎と診断し，胸骨正中切開で心膜切除術を施行した．心膜は皮革状の肥厚を認め，心外膜に強固に癒着していた．心膜切除により，術中から中心静脈圧の低下に加え肉眼的にも右室収縮の改善を認めた．術後1年現在経過良好である．心臓手術後の収縮性心膜炎は稀な合併症であるが，特に低侵襲手術後の収縮性心膜炎の報告は過去になかったため，文献的考察を加えて報告する．
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Ozeki et al. (2018) conducted a case report in Constrictive pericarditis (n=1). Pericardiectomy was evaluated on Clinical and hemodynamic improvement. Pericardiectomy reduced central venous pressure from 18 mmHg to 11 mmHg and instantaneously improved right ventricular motion, resulting in NYHA Class I status at one year.
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