Clinical dilemmas
Pericardial constriction after cardiac transplantation

https://doi.org/10.1016/j.healun.2009.07.015Get rights and content

In this study we present a series of 5 cases that developed constrictive pericarditis after orthotopic heart transplantation. All 5 patients had pericardial effusion of non-infectious etiology in the early post-transplant period. They subsequently presented with heart failure unresponsive to standard medical management. The diagnosis was made by comprehensive echo-Doppler studies. Findings were confirmed at surgical inspection and complete pericardiectomy led to improvement in hemodynamics in 4 patients. One patient had relief from constriction but died of non-cardiac complications. One patient with constriction has been re-listed for transplantation due to intermittent heart block and associated cardiac allograft vasculopathy. Early diagnosis of pericardial constriction after orthotopic heart transplantation requires a high index of clinical suspicion and optimal use of Doppler echocardiography. Early diagnosis and timely surgical pericardiectomy may correct this condition entirely and result in satisfactory long-term results.

Section snippets

Methods

We performed a search of our institution's echocardiographic database and identified all patients who had evidence of pericardial constriction after orthotopic heart transplantation. Our surgical database was also searched to capture cases that had undergone peri-cardiectomy for post-transplant constriction. We then proceeded to review their medical and surgical records and collected information regarding clinical, imaging, hemodynamic, and pathologic results. The number of diagnosed and

Results

Between January 1986 and May 2009, 127 adult OHT procedures were performed at our institution. After OHT, serial echocardiographic studies are performed per institutional protocol. Review of this database revealed the presence of pericardial effusions of varying sizes in 53 patients (42% of all cases) in the early post-operative period (average 27 days). In the great majority of cases, the effusion resolved spontaneously in the subsequent 3 months without consequences. Five patients developed

Post-transplant constrictive pericarditis

Constrictive pericarditis is an infrequent, but well-documented complication of cardiac surgery.2, 3, 4, 5, 6, 7, 8 It was first reported in 19722 and may develop after any cardiac surgical procedure, including coronary bypass grafting, valve surgery, and repair of congenital lesions.2, 3, 4, 5, 6, 7, 8 The incidence of post-surgical constriction ranges from 0.1% to 0.3%.5, 6, 7 In developing countries, the most common etiology of constriction continues to be tuberculosis.8 In the United

Disclosure Statement

The authors have no conflicts of interest to disclose.

References (24)

Cited by (18)

  • Clinical features and prognosis of surgically proven constrictive pericarditis after orthotopic heart transplantation

    2021, Journal of Heart and Lung Transplantation
    Citation Excerpt :

    With the latter, a sustained reaction to the implanted material has been reported, precipitating inflammatory pericardial contraction, and, potentially, post-OHT CP.11 Consistent with previous reports,2,3,5–7 CP in the presented cohort occurred months to years after OHT, developing more slowly and variably than CP after CABG alone.12 Although potentially an artifact of sample size, this variability may have resulted from inherent differences in these populations, including differences in age, comorbidities, residual pericardium, surgical technique, and—perhaps most importantly—the influence of transplant-specific immunosuppressive therapies.

  • Clinical Features of Restrictive Cardiomyopathy and Constrictive Pericarditis

    2018, Heart Failure in the Child and Young Adult: From Bench to Bedside
  • Clinical Features of Restrictive Cardiomyopathy and Constrictive Pericarditis

    2017, Heart Failure in the Child and Young Adult: From Bench to Bedside
View all citing articles on Scopus
View full text