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Thomas J. Hinkamp
Henry J. Sullivan
Alvaro Montoya
Soon Park
Roque Pifarre
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Ann Thorac Surg 1994;57:1579-1583
© 1994 The Society of Thoracic Surgeons

Articles

Chronic cardiac rejection masking as constrictive pericarditis

Thomas J. Hinkamp, MD*, Henry J. Sullivan, MD, Alvaro Montoya, MD, Soon Park, MD, Linda Bartlett, RN, Roque Pifarre, MD

Loyola University Medical Center, Maywood, Illinois, USA

Accepted for publication October 18, 1993.

* Address reprint requests to Dr Hinkamp, Loyola University Medical Center, 2160 South First Ave, Maywood, IL 60153.

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.






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Copyright © 1994 by The Society of Thoracic Surgeons.