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Chronic cardiac rejection masking as constrictive pericarditis
T J Hinkamp1, H J Sullivan, A Montoya
1Loyala University Medical Center, Maywood, Illinois 60153.
Insights
Constrictive pericarditis after heart transplant presents variable outcomes. Pericardiectomy improved one patient, but three showed persistent high pressures, suggesting coexisting conditions impacting results.
Area of Science:
- Cardiology
- Cardiac Surgery
- Transplantation Medicine
Background:
- Hemodynamic changes resembling constrictive pericarditis are common in heart transplant recipients.
- Constrictive pericarditis involves a thickened pericardium restricting heart function.
- Post-transplant cardiac complications can include pericardial disease.
Purpose of the Study:
- To evaluate the outcomes of pericardiectomy in heart transplant patients with constrictive pericarditis.
- To identify factors influencing clinical improvement after pericardiectomy in this population.
Main Methods:
- Retrospective case series of 4 heart transplant recipients undergoing pericardiectomy.
- Surgical exploration to assess pericardial thickness and constriction.
- Postoperative monitoring of clinical status and hemodynamic pressures.
Main Results:
- One patient with effusive constriction showed significant improvement post-surgery.
- Three patients did not improve, exhibiting persistent elevated atrial and ventricular end-diastolic pressures.
- Poor outcomes may be linked to restrictive cardiomyopathy from chronic rejection or coronary arteriopathy.
Conclusions:
- Pericardiectomy outcomes in heart transplant patients are variable.
- Coexisting restrictive cardiomyopathy can negatively impact results after pericardiectomy.
- Careful patient selection is crucial for optimizing outcomes in constrictive pericarditis post-transplant.
Abstract:
The hemodynamic changes consistent with constrictive pericarditis are often encountered in patients who have undergone cardiac transplantation. We describe here 4 patients who underwent pericardiectomy after cardiac transplantation. All were found to have evidence of a thickened and constricting peel of pericardium at surgical exploration. Their postoperative clinical courses were variable. One patient with primarily effusive constriction experienced marked improvement. Three patients failed to show clinical improvement and had persistently elevated atrial and ventricular end-diastolic pressures. A coexisting restrictive cardiomyopathy secondary to chronic rejection, coronary arteriopathy, or long-standing constriction may have been the cause of this poor outcome. Many patients with transplanted hearts exhibit evidence of poor diastolic ventricular compliance without evidence of classic constriction; some manifest both the restrictive and constrictive components. The careful selection of patients with constrictive pericarditis can optimize the outcome.