An autopsy case of constrictive pericarditis following open chest surgery with severe pulmonary hypertension treated as HFpEF.

UNLABELLED: A 73-year-old man with a history of aortic arch replacement for chronic type B aortic dissective aneurysm was admitted for heart failure. He had normal left ventricular systolic function and had pulmonary hypertension with a pulmonary artery pressure of approximately 90 mmHg. He had been diagnosed with pneumoconiosis from his occupation and pulmonary hypertension due to heart failure with preserved ejection fraction (HFpEF) and respiratory disease. The patient continued to be treated for heart failure but died from pneumonia. An autopsy revealed a finding of full circumferential adhesions of the pericardium and myocardium. The lung had severe pleural adhesions and pulmonary interstitium showed peri bronchial interstitial changes and stasis of blood flow. Mild intimal thickening of the pulmonary vessels was noted. The patient was diagnosed with constrictive pericarditis mimicking HFpEF due to pericardial adhesion after open chest surgery. Significant pulmonary hypertension was thought to have been brought about by respiratory disease involving pleural adhesions due to surgery, in addition to being due to left heart disease due to constrictive pericarditis.

LEARNING OBJECTIVES: 1.When we see unexplained heart failure with preserved ejection fraction, we need to search for extra-cardiac causes as well.2.In cases of pulmonary hypertension that cannot be explained by an isolated condition, other complicating conditions must be pursued.