DIAGNOSIS AND SURGICAL TREATMENT (CARDIAC DECORTICATION) FOR VIRAL CONSTRICTIVE EPICARDITIS

Constrictive pericarditis is a rare disease, and its diagnosis may be difficult in the absence of the typical thickening and calcification of the pericardial leaflets, due to the variety of forms and clinical manifestations of the disease often masked by symptoms of other diseases. The article presents a rare case of a 16-year-old patient with viral epicarditis and severe hemodynamic picture of heart failure as a result of constriction not accompanied by a typical thickening of the pericardium. At first in the absence of specific changes in echocardiography and radiography, the differential diagnosis was carried out between cardiomyopathy, myocarditis and liver diseases. Liver disease was suspected, however, after drug therapy symptoms of heart failure remained. Computed tomography and especially echocardiography showed no pronounced signs of constriction - the volume of heart ventricles was not reduced, there were no areas of calcification and gross fibrosis of the outer pericardial leaflet. When reviewing the data of magnetic resonance tomography we were able to identify thickening of the visceral pericardial leaflet - epicarditis. The operation was performed - epicardiectomy (cardiac decortication), subtotal pericardectomy. The clinical case presented demonstrates the importance of comparing data obtained by different methods of radiation diagnosis for determining the epicardial compression, and the obligatory implementation of epicardial decortication in the surgical treatment to achieve the desired hemodynamic effect. This material can be useful for correct interpretation of the examination data and the choice of surgical treatment tactics.

Adler Y., Charron P., Imazio M., Badano L., Baron-Esquivias G., Bogaert J. et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC). Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur. Heart J. 2015; 36 (42): 2921-64. DOI: 10.1093/eurheartj/ehv318

Барбухатти К.О., Белаш С.А., Якуба И.И., Яблонский П.П., Скопец А.А., Порханов В.А. Случай успешного хирургического лечения констриктивного перикардита после трансплантации сердца. Вестник трансплантологии и искусственных органов. 2012; 14 (2): 61-6. [Barbukhatti K.O., Belash S.A., Yakuba I.I., Yablonsky P.P., Skopets A.A., Porkhanov V.A. Successful surgical treatment of constrictive pericarditis after heart transplantation. Vestnik Transplantologii i Iskusstvennykh Organov (Russian Journal of Transplantology and Artificial Organs). 2012; 14 (2): 61-6 (in Russ.).]

George T.G., Arnaoutakis G.J., Beaty C.A., Kilic A., Baumgartner W.A., Conte J.V. Contemporary etiologies, risk factors, and outcomes after pericardiectomy. Ann. Thorac. Surg. 2012; 94 (2): 445-51. DOI: 10.1016/j.athoracsur.2012.03.079

Yared K., Baggish A.L., Picard M.H., Hoffmann U., Hung J. Multimodality imaging of pericardial diseases. JACC Cardiovasc. Imaging. 2010; 3 (6): 650-60. DOI: 10.1016/j.jcmg.2010.04.009

Buscha C., Penov K., Amorim P.A., Garbade J., Davierwala P., Schuler G.C. et al. Risk factors for mortality after pericardiecto-my for chronic constrictive pericarditis in a large single-centre cohort. Eur. J. Cardiothorac. Surg. 2015; 48 (6): e110-6. DOI: 10.1093/ejcts/ezv322

Ferreira R., Gonzaga A., Santos L., Santos J.A. Recurrent constrictive pericarditis: a diagnostic and therapeutic challenge. Rev. Port. Cardiol. 2015; 34 (6): 421.e1-5. DOI: 10.1016/j.repc.2014.11.009