Pericardial pathology detected preoperatively in a patient undergoing mitral valve repair: a case report

BACKGROUND: Severe intrapericardial adhesions, regardless of their etiology, represent a major challenge in cardiac surgery. Such adhesions increase the risk of cardiac injury, excessive bleeding, and technical difficulty in establishing cardiopulmonary bypass, thereby necessitating meticulous preoperative planning and careful intraoperative management. CASE PRESENTATION: Herein, we report a 74-year-old female patient who required cardiac surgery in the presence of severe pericardial adhesions. Echocardiography demonstrated severe mitral regurgitation due to P3 prolapse, accompanied by progressive left atrial enlargement. Preoperative imaging findings suggested the presence of dense pericardial adhesions; therefore, a median sternotomy was selected with careful surgical planning. The patient underwent mitral valve repair with artificial chordae implantation and annuloplasty, along with concomitant tricuspid valve repair. Intraoperatively, extensive intrapericardial adhesions were confirmed, requiring cautious and meticulous dissection to avoid cardiac injury. The postoperative course was uneventful, and mitral regurgitation improved to a minimal degree. The patient was discharged on postoperative day 12 and remained free from heart failure symptoms during follow-up. CONCLUSION: Severe pericardial adhesions can substantially increase the complexity and risk of cardiac surgical procedures, irrespective of the underlying cause. Accurate preoperative assessment, anticipation of technical difficulties, and selection of an appropriate surgical strategy are crucial for ensuring procedural safety and achieving favorable surgical outcomes.