2018 FSA Posters

P037: CONSTRICTIVE PERICARDITIS WITH COMPRESSION OF RIGHT VENTRICLE BY CONCOMITANT PERICARDIAL CYSTIC MASS
James Brown, DO, Mark Simpsen, MD, Albert Robinson, MD; University of Florida

Introduction: Constrictive pericarditis (CP) is a subset of pericardial disease and arises from inflammation and fibrosis of the parietal and visceral pericardium.  Progression of the disease leads to impaired diastolic filling and ultimately right heart failure (1).  Etiologies include idiopathic (most common cause), prior cardiac surgery, mediastinal radiation, and scarring due to infection causes (3).  Pericardial cysts (PC) are the most common benign tumors of the pericardium occurring in 1 in 100,000 people (2).  If large enough, they can cause symptoms of cough, chest pain, and dyspnea.  Surgical pericardiectomy/pericardial stripping are treatment options for CP, along with removal or drainage for PC.  This case presents the diagnosis, surgical treatment, intraoperative management and TEE findings of constrictive pericarditis and pericardial cystic mass.

Case Presentation: A 59 y/o male with a past medical history of atrial fibrillation (AF), hypertension, and pulmonary embolism was admitted for increasing shortness of breath, chest pain, fatigue and decreased functional status over the past two months.  Further diagnostic workup led to the diagnosis of CP with a large PC abutting the right ventricle.  The patient was taken to the operating room for a pericardiectomy and removal of PC.  Upon placement of a central venous line and pulmonary artery catheter (PAC), central venous pressure (CVP) and pulmonary artery pressure (PAP) were elevated.  Transesophageal echocardiography (TEE) demonstrated reduced ejection fraction, thickened and hyperechoic pericardium, diastolic dysfunction, abnormal interventricular septal movement, and a large echo-lucent collection abutting the lateral aspect of the right ventricle.  Cardiopulmonary bypass (CPB) was instituted due to extensive cardiac manipulation required to removed affected pericardium.  After conclusion of the procedure and removal from CPB, the patient had reduced CVP, improved PAP, and a mildly dilated right ventricle.  The patient was taken to the ICU in stable condition.  At his one month follow up, the patient reported resolution of his admitting symptoms. 

Discussion: This case demonstrates the clinical course and treatment of CP and symptomatic PC.  This case demonstrates classic preoperative and intraoperative findings associated with CP/PC, and there is a paucity in the literature regarding CP with coexisting PC suggesting this is a rare combination.