Department of Surgery, Division of Cardiac Surgery, Jefferson-Einstein Medical Center, Philadelphia, PA, USA.
Jefferson-Einstein Medical Center, 5501 Old York Road, Klein Building-Suite 401, Philadelphia, PA, 19141, USA.
J Cardiothorac Surg. 2024 Jul 13;19(1):442. doi: 10.1186/s13019-024-02950-1.
The COVID-19 pandemic was primarily considered a respiratory malady in the early phases of the outbreak. However, as more patients suffer from this illness, a myriad of symptoms emerge in organ systems separate from the lungs. Among those patients with cardiac involvement, myocarditis, pericarditis, myocardial infarction, and arrhythmia were among the most common manifestations. Pericarditis with pericardial effusion requiring medical or interventional treatments has been previously reported in the acute setting. Notably, chronic pericarditis with pericardial thickening resulting in constriction requiring sternotomy and pericardiectomy has not been published to date.
A patient with COVID-19-associated constrictive pericarditis three years after viral infection requiring pericardiectomy was reported. The COVID-19 infection originally manifested as anosmia and ageusia. Subsequently, the patient developed dyspnea, fatigue, right-sided chest pressure, bilateral leg edema, and abdominal fullness. Following recurrent right pleural effusions and a negative autoimmune work-up, the patient was referred for cardiothoracic surgery for pericardiectomy when radiographic imaging and hemodynamic assessment were consistent with constrictive pericarditis. Upon median sternotomy, the patient's pericardium was measured to be 8 mm thick. Descriptions of the clinical, diagnostic, and therapeutic features are provided. Within the first week after the operation, the patient's dyspnea resolved; one month later, leg edema and abdominal bloating were relieved.
Although an association between COVID-19 and cardiac complications has been established, this case adds another element of virus severity and chronic manifestations. The need for sternotomy and pericardiectomy to treat COVID-19-related constrictive pericarditis is believed to be the first reported diagnosis.
COVID-19 大流行在疫情早期主要被认为是一种呼吸道疾病。然而，随着越来越多的患者患有这种疾病，除了肺部以外的其他器官系统也出现了多种症状。在患有心脏受累的患者中，心肌炎、心包炎、心肌梗死和心律失常是最常见的表现。以前在急性发病时已经报道过需要医疗或介入治疗的心包炎伴心包积液。值得注意的是，目前尚未发表因心包增厚导致缩窄需要开胸和心包切除术的慢性心包炎。
报告了一名 COVID-19 相关缩窄性心包炎患者，该患者在病毒感染三年后需要进行心包切除术。COVID-19 感染最初表现为嗅觉丧失和味觉丧失。随后，患者出现呼吸困难、疲劳、右侧胸部压迫感、双侧腿部水肿和腹部饱胀。在反复出现右侧胸腔积液和自身免疫检查阴性后，当影像学检查和血液动力学评估符合缩窄性心包炎时，患者被转诊进行心胸外科心包切除术。正中开胸时，患者的心包厚度为 8 毫米。提供了临床、诊断和治疗特征的描述。手术后第一周，患者的呼吸困难得到缓解；一个月后，腿部水肿和腹部肿胀得到缓解。
虽然已经确定 COVID-19 与心脏并发症之间存在关联，但该病例增加了病毒严重程度和慢性表现的另一个因素。需要进行开胸和心包切除术来治疗 COVID-19 相关的缩窄性心包炎，据信这是首例诊断。
