A Patient with Extremely Severe Constrictive Pericarditis Underwent Emergency Pericardiectomy Without Cardiopulmonary Bypass

We report a case of a 58-year-old man admitted to hospital with severe constrictive pericarditis. An emergency pericardiectomy was planned due to the patient's orthopnea associated with hemodynamic instability. The patient performed pericardiectomy without cardiopulmonary bypass. The patient was found to be orthopnea and began to experience disturbance of consciousness after entering the operating room. Non-invasive blood pressure was 100/54 mmHg, accompanied by atrial fibrillation, the ventricular rate was 158 beats/min, and arterial oxygen saturation was 90% with air inhalation. After intubation, the ventricular rate rose to 187 beats/min, the blood pressure dropped to 65/45 mmHg, and vasopressors were urgently administered to maintain circulatory stability. At the same time, the internal jugular vein cannula was placed ultrasound-guided. During the operation, the central venous pressure (CVP) increased to 41.2 cmH2O, and cerebral oxygen saturation dropped to 47.6%. Although the patient with severe constrictive pericarditis, we still performed pericardiectomy without cardiopulmonary bypass. The operation time was about 3 hours, and the patient was successfully transferred to the Intensive Care Unit (ICU) to continue monitoring and treatment, and the tracheal intubation was removed 48 hours after the operation and he was discharged 19 days after the operation. Real-time transesophageal echocardiography (TEE) monitoring played a crucial role in intraoperative management.