Severe Case of Idiopathic Chronic Pericarditis Treated by Video Transthoracic Pericardial Fenestration

Idiopathic chronic pericarditis is rare and difficult to treat. Most cases are benign and self-limited; however, a small number of cases develop severe symptoms and could be fatal. They may be refractory to medication and pericardiocentesis. We report a case of severe pericarditis in an 83-year-old patient who presented with systemic edema, weight gain of 15 kg over 2 years, jaundice, and shortness of breath. Chest CT scan and echocardiogram revealed a massive pericardial effusion, which suggested chronic pericarditis. Edema was resolved with diuretics, but pericardial effusion remained. Pericardiocentesis was performed, and the etiology was unknown. The patient developed an ischemic stroke, and the treatment for recurrent pericarditis became very difficult. Thoracoscopic left atrial appendage (LAA) clipping and pericardial fenestration were performed simultaneously. The patient was free from recurrence for 8 weeks. Such recurrent pericarditis with severe symptoms that require surgical treatment is rare. Transthoracic pericardial fenestration could be an optimal treatment for such high-risk patients.