When Heart Failure has to do with Past Abdominal Surgery

A 70-year-old woman, with a past medical history of permanent atrial fibrillation, cholecystectomy for symptomatic gallstones and obesity (54 kg/m2 body mass index), was admitted to the hospital for rapidly increasing dyspnea (NYHA class III). At admission, heart rate was 110 beats per minute(bpm) and blood pressure was 125/73 mmHg. Physical examination revealed clinical signs of right heart failure including major peripheral oedema, hepatomegaly, bilateral pleural effusion, and ascites with no signs of portal hypertension or hepatocellular insufficiency.

On the first transthoracic echocardiogram, preserved left ventricular ejection fraction with normal diastolic function was noticed. Interestingly, a major dilatation of the right ventricle, the right atrium, and the inferior vena cava (45 mm) were observed. Systolic pulmonary artery pressures were estimated as high as 60 mmHg with the tricuspid regurgitation, and cardiac index was increased, reaching 4.8 L/min/m2. Pulmonary assessment on the six-minute walk test was satisfying at 255 meters, and a small restrictive impairment was documented on a pulmonary function test (assigned to obesity). Finally, no perfusion defect was found on the ventilation/perfusion lung scan.