収縮性心外膜炎に対して心外膜剥離術が奏功した透析患者の１例

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  • A dialysis patient with constrictive pericarditis successfully treated with pericardiectomy
  • ショウレイ ホウコク シュウシュクセイシン ガイ マクエン ニ タイシテ シン ガイ マク ハクリジュツ ガ ソウコウ シタ トウセキ カンジャ ノ 1レイ

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We encountered a case of constrictive pericarditis developing in a 56-year-old man who had been on dialysis for about 24 years. He was hospitalized for anorexia, nausea, ascites, and edema. However, he was diagnosed as having constrictive pericarditis due to the pericardial calcification observed on chest X-ray, and dip and plateau pattern of the right ventricular pressure curve observed on cardiac catheterization. CTR (cardiothoratic ratio) did not change, but ascites and edema tended to improve while dry weight was reduced. Neither cardiac function nor hypotension during dialysis improved with dry weight reduction. The patient underwent pericardiectomy because the condition was considered to result from constrictive pericarditis. Pericardial calcification, which was confirmed through perioperative exploration, was considered to cause dilation disorder, resulting in reduced cardiac output and blood pressure. Pathologic examination demonstrated severe calcification and fibrous thickening of the pericardium and infiltration of multinucleated cells to phagocytize the calcified tissue. Since there was no apparent caseous necrosis, constrictive pericarditis was considered to be idiopathic, not tuberculous. The postoperative course was uneventful. Blood pressure, CTR, left ventricular ejection fraction, and cardiac output all increased. Constrictive pericarditis in dialysis patients may result in ventricular dilation disorder, frequently causing hypotension during dialysis. It is necessary for such patients to undergo early pericardiectomy to improve cardiac function, thereby ensuring stable dialysis.

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