A Case of Early Phase Dialysis Associated Effusive Constrictive Pericarditis With Distinct Surgical Findings

Abstract

SummaryA 55-year-old male patient with a 10 year history of hemodialysis was admitted for examination of pericardial effusion. Specific echocardiography, MRI, and cardiac catheterization findings strongly suggested a diagnosis of effusive constrictive pericarditis. Pericardiectomy showed the following distinct findings. Two layers of fibrous tissue below the thickened pericardium emerged. The cardiac constriction had not been relieved until the inner layer was partially resected. We conclude that patients in dialysis associated constrictive pericarditis should undergo pericardiectomy before the adhesion between fibrous tissues becomes hard. Case ReportThe patient was a 55 year-old male. He had been started on maintenance hemodialysis due to chronic glomerulonephritis 10 years earlier. Moderate inflammatory reaction with C-reactive protein of 6.8 mg/dL was detected in 2008 in a dialysis clinic. Chest computer tomography revealed mild pericardial effusion and bilateral pleural effusion. Therefore, even intensive dialysis for one month could not remove the effusion or improve the inflammatory reaction. He was referred to our hospital due to the refractory pericardial effusion.His blood pressure was 101/66 mmHg, the pulse rate was 84 beats per minute, and the oxygen saturation was 98%. Auscultation of the chest revealed no apparent abnormalities, including knock sound. Neither jugular venous distention nor pretibial pitting edema was present. Laboratory findings on admisFrom the

Dialysis-related constrictive pericarditis: old enemies may sometimes come back

“…The pathophysiology of pericarditis associated with CKD includes uremia, a condition conducive to chronic inflammation status and serositis, hypervolemia, acid-base disorders, fluid and electrolyte disorders, calcium metabolism disorders, phosphorus metabolism disorders, and a baseline hypercatabolic state 4 , 7 , 13 .…”

“…Pericarditis cases related to CKD and uremia are divided into two subgroups: uremic pericarditis, when the condition develops before starting dialysis or up to eight weeks into dialysis and Dialysis-related constrictive pericarditis, a condition which develops from eight weeks of dialysis. The rationale behind the elected cut-off is that eight weeks should be enough for uremia and hypervolemia (two common conditions at the start of dialysis) to be resolved 4 , 7 , 13 . ( )…”

“…Cases of DRCP have been described to affect individuals on hemodialysis 7,9,[16][17][18] and peritoneal dialysis 13,19,20 . Reported cases generally date back to times when filters were not as efficient at removing solutes and patients remained uremic in spite of therapy 17,18 .…”

“…Pericardial involvement in patients with CKD is multifactorial and generally related to conditions leading to ineffective dialysis such as hypercatabolic status and low dose of delivered therapy 7 , 8 . In this context, chronic exposure to a uremic environment leads to inflammatory alterations in the pericardium and to the subsequent onset of fibrosis and constrictive pericarditis 4 , 9 .…”

Effusive-Constrictive Pericarditis Post Surgical Revision for Iatrogenic Hemopericardium

“…The syndrome was described in the literature several decades ago by Burchell and Spodick 1,2 . The knowledge related to effusive-constrictive pericarditis results from case reports and clinical trials with a limited Effusive-constrictive pericarditis post surgical revision for iatrogenic hemopericardium number of participants only [3][4][5][6][7][8][9] . In the prospective study carried out by Sagristà-Sauleda 7 , the prevalence of this disorder was 1.3% in patients with pericardial disease of any type and 6.9% in patients with cardiac tamponade.…”