Cardiac transplantation for cardiomyopathy with constrictive pericarditis

Area of Science:

• Cardiology
• Cardiac Surgery
• Cardiovascular Pathology

Background:

• Constrictive pericarditis, historically termed "Concretio Cordis," presents diagnostic challenges due to its mimicry of other cardiovascular and systemic diseases.
• Differential diagnosis often includes restrictive cardiomyopathy, endomyocardial fibrosis, and chronic liver or renal disease, complicating clinical assessment.

Observation:

• This report presents the first clinical account of constrictive pericarditis in patients undergoing cardiac transplantation.
• Two distinct cases of cardiomyopathy necessitating cardiac transplantation are described, complicated by concomitant pericardial constriction.

Findings:

• The first case illustrates constrictive pericarditis acting as a "cardiac support device," potentially aiding ventricular remodeling by reducing wall stress in heart failure.
• The second case serves as a cautionary example against using biological pericardial substitutes, such as bovine pericardium, as a pericardial substitute due to adverse outcomes.

Implications:

• Understanding the varied presentations of constrictive pericarditis is crucial for accurate diagnosis, especially in complex cardiac conditions.
• These cases underscore the importance of considering pericardial disease in patients with cardiomyopathy referred for transplantation and evaluating the long-term efficacy of pericardial substitutes.