Constrictive Pericarditis after Paediatric Cardiac Surgery: Case Report and Literature Review

Objective: Constrictive pericarditis (CP) is a rare occurrence post cardiac surgery in paediatric patients. Its cause is largely hypothetical and there is usually nothing significant found on review of the patients’ peri-operative course. However, it is an important entity as it contributes significantly to morbidity and mortality. We aim to improve awareness of this rare complication for paediatricians involved in the post-operative care of patients with cardiac conditions.

Case and Literature Review: We present a case of a 10 year old child with a history of doubly committed juxta-arterial ventricular septal defect (VSD) who underwent patch closure via midline sternotomy. He presented 15 months later with reduced effort tolerance and was diagnosed to have CP and bilateral pleural effusions. He underwent a pericardiectomy and was discharged after 2 weeks.

CP is a well-known complication post cardiac surgery in adult literature. However, to our knowledge, there are only 6 cases of CP occurring as a complication post cardiac surgery in current paediatric literature, making our case the 7^th report. Of the 7, there are 4 cases noted occurring post VSD closures, denoting a possible implication. Pericardiectomy remains the definitive form of therapy for post-operative CP and majority of paediatric cases do well post-pericardiectomy.

Conclusion: CP is a rare but important complication post invasive heart surgery in children. Time of occurrence is variable ranging from months to years post-surgery. Presentation may be non-specific and clinicians need to be aware of the condition to have a high index of suspicion. Majority of paediatric cases do well post-pericardiectomy which is the treatment of choice in this condition. This is in contrast with reports from adult literature and may be attributed to comorbidities and nature of cardiac surgery in the adult population.

Pooling data from current and future literature would be beneficial for further research.