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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.
The Annals of Thoracic Surgery
|June 1, 1994
Summary
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.