Constrictive Pericarditis with Repeated Hepatic Encephalopathy Associated with Hepatic Cirrhosis : A Case Report
- VernacularTitle:原因不明の肝硬変による繰り返す肝性脳症と診断されていた収縮性心膜炎の1例
- Author:
Shuji MORIYAMA
1
;
Masahiko HARA
1
;
Yasushi KANEKO
1
Author Information
- Keywords: constrictive pericarditis; hepatic encephalopathy; hepatic cirrhosis
- From:Japanese Journal of Cardiovascular Surgery 2019;48(3):173-178
- CountryJapan
- Language:Japanese
- Abstract: We report a case of constrictive pericarditis with repeated hepatic encephalopathy due to hepatic cirrhosis. A 69-year-old man with exertional dyspnea and leg edema was admitted to our hospital. He had been admitted to our hospital thrice in the past 1 year owing to hepatic encephalopathy. He had hyperammonemia, hyperbilirubinemia, and renal dysfunction. Computed tomography revealed a thick pericardium with calcification and bilateral pleural effusion, and transthoracic echocardiography revealed abnormal early diastolic septal movement and right ventricular restriction. Further, cardiac catheterization identified increased central venous (36 mmHg) and a mean pulmonary arterial of 53 mmHg and a dip-and-plateau right ventricular pressure curve. We diagnosed constrictive pericarditis. Accordingly, pericardiectomy without extracorporeal circulation was performed. A hypertrophic calcified pericardium was found to be expanded throughout the right atrium to the free wall of the right ventricle. Postoperatively, the patient's exertional dyspnea and leg edema resolved, and he recovered without any complications.
