Constrictive pericarditis after coronary artery bypass surgery as a cause of unexplained dyspnea: A report of five cases

• Published in: Clinical cardiology (Mahwah, N.J.) Vol. 21; no. 9; pp. 691 - 694
• Main Authors: Dardas, Petros, Tsikaderis, Dimitris, Ioannides, Efstathios, Bisbos, Apostolos, Smirlis, Dimitris, Arditis, Iakovos, Spanos, Panagiotis
• Format: Journal Article
• Language: English
• Published: New York Wiley Periodicals, Inc 01.09.1998; Wiley
• Subjects: Aged; Biological and medical sciences; Cardiac Catheterization; constrictive pericarditis; Coronary Angiography; Coronary Artery Bypass - adverse effects; coronary artery bypass grafting; Dyspnea - etiology; Echocardiography; Echocardiography, Transesophageal; Fatal Outcome; Female; Humans; Male; Medical sciences; Middle Aged; Pericardiectomy; Pericarditis, Constrictive - diagnosis; Pericarditis, Constrictive - etiology; Pericarditis, Constrictive - therapy; Short Communication; Short Communications; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; unexplained dyspnea; Sonography; Human; Heart failure; Pericardial constriction; Echocardiography; Respiratory disease; Cardiovascular disease; Exploration; Case study; Symptomatology; Dyspnea; Treatment; Aortocoronary; Bypass; Heart disease; Surgery; Pericardial disease; Complication; Graft; Diagnosis
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.4960210917

Constrictive pericarditis after coronary artery bypass grafting (CABG) is rare and can present as unexplained dyspnea. We report five consecutive cases of post‐CABG constrictive pericarditis seen within a period of 17 months at our institution. All patients presented with heart failure of unknown etiology within a period of 8‐84 months after surgery. During the initial post‐CABG period, two patients had developed postcardiotomy syndrome that was successfully treated with steroids. They were all assessed noninvasively and invasively. In all patients, the diagnosis of constriction was initially suspected clinically (symptoms, high jugular venous pressure with deep “X” and “Y” descents, pericardial knock). Echocardiography showed transmural flow typical of constriction in all patients and hepatic venous flow in two. Two patients showed rapid left ventricular relaxation. In all patients, hemodynamic assessment showed diastolic equalization of pressures in all chambers, “W” shape waveform in right atrial pressure, and “dip and plateau” configuration in right and left ventricular pressure waveforms. Diagnosis was confirmed surgically in four patients who were subjected to pericardiectomy‐pericardial stripping (three survived, one died). One patient refused surgery. We conclude that constrictive pericarditis, although rare, should be suspected in every case of unexplained dyspnea post CABG. It can appear early or late after surgery, and clinical examination plays an important role in its early recognition. It requires a full noninvasive and invasive assessment in case of clinical suspicion.