Surgical resection of enlarged calcification formed by idiopathic localized constrictive pericarditis during total aortic arch replacement for aortic dissection

Abstract

A 75-year-old woman presented at a prior hospital with persistent cough and was treated conservatively for a thrombosed-type aortic dissection (Stanford A). One-year after discharge, follow-up computerized tomography revealed a DeBakey type II, chronic dissecting aortic aneurysm enlarged to 54 mm. She was referred to our hospital with slight edema in the face and extremities and chest radiography showed calcification around the heart. Computerized tomography performed at the prior hospital showed a large spherical mass in the anterior pericardium in addition to the aortic dissection. We therefore resected the mass immediately before a total aortic arch replacement. Surgery was successful and uneventful with patient discharge on postoperative day 21. The final differential diagnosis was idiopathic, localized, constrictive pericarditis. K E Y W O R D S aorta and great vessels, cardiovascular pathology, constrictive pericarditis 1 | INTRODUCTION Constrictive pericarditis (CP) is an uncommon disorder characterized by pericardial thickening, myocardial constriction, and progressively impaired diastolic filling. A number of causes exist, including tuberculosis, uremia, dialysis, viral or bacterial infection, traumatic or nontraumatic pericardial hematoma, and autoimmune disease. Patients often present with generalized symptoms of cardiac failure, such as edema within the extremities and hepatic congestion, but localized pericardial constriction is rarely reported. Although a few cases of CP requiring surgical resection of calcified masses in compressed right ventricles have been reported, idiopathic case reports are scarce. Here, we present an elderly woman with a thrombosed aortic dissection who developed idiopathic, CP-mediated calcification of the anterior pericardium 1 year after the onset of aortic dissection and required a surgical resection of this mass during an aortic arch replacement. | CASE REPORTA 75-year-old woman with persistent cough presented at a prior hospital, where computerized tomography (CT) found a large spherical mass in the anterior pericardium and a thrombosed-type Stanford A aortic dissection with a maximum aortic diameter of 48 mm and false lumen thickness of 7 mm that was treated conservatively. The onset time of the aortic dissection was unknown.One year after the first admission, follow-up CT revealed a false lumen communication and the ascending aorta was enlarged to 54 mm in diameter. She was referred to our hospital for surgery and complained of fatigue upon admission. She denied any previous history of chest wall trauma or bleeding disorders and had no history of tuberculosis or radiation therapy.CT and X-rays performed at the prior hospital also showed a large spherical mass in the anterior pericardium compressing the right atrium and ventricle in addition to the referred aortic dissection J Card Surg. 2019;34:511-513.wileyonlinelibrary.com/journal/jocs

The Clinical Efficacy of Cedilanid and Isosorbide Dinitrate plus Pericardial Dissection for Chronic Constrictive Pericarditis in the Elderly and Its Influence on Plasma Endothelin, Atrial Natriuretic Peptide, and Systemic Immune-Inflammation Index

“…The Hospital Anxiety and Depression (HAD) scale [ 11 ] was used to assess the emotional state of patients before and after the intervention. The scale has a total score of 42 points.…”