Constrictive Pericarditis After Lung Transplantation

Abstract

As a rare complication after lung transplant, cardiac constriction should not be missed. Physical exam, echocardiography, and catheterization are essential for diagnosis A 65-year-old man with previous coronary artery disease and idiopathic pulmonary fibrosis underwent bilateral lung transplant and subsequently presented for progressive dyspnea and volume overload. Cardiac imaging and cardiac catheterization confirmed constriction, and complete pericardiectomy was performed. The patient had rapid resolution of heart failure symptoms. Pericardial constriction is a rare complication following lung transplant, and we provide a review of the literature and discussion of potential contributing factors. ( Level of Difficulty: Intermediate. )

When the Neighbor Is at Fault

“…Logan et al. ( 3 ) present a case that highlights diagnostic dilemmas, appropriate testing, and ultimately successful surgical intervention.…”

“…In this issue of JACC: Case Reports, Logan et al. ( 3 ) describe an interesting case of a 65-year-old man with idiopathic pulmonary fibrosis who underwent bilateral lung transplantation complicated by new onset heart failure. After considering a broad differential and performing extensive workup, the investigators concluded that the most likely etiology was constrictive pericarditis.…”

“…After considering a broad differential and performing extensive workup, the investigators concluded that the most likely etiology was constrictive pericarditis. CP is a rare entity ( 3 ). Risk of progression to CP is low (<1%) in viral and idiopathic pericarditis, intermediate (2% to 5%) in immune-mediated pericarditis and neoplastic pericardial diseases and high (20% to 30%) in bacterial pericarditis ( 4 ).…”

“…There are also disease-specific risk factors pertinent to patients post-lung transplantation that Logan et al. ( 3 ) indicate: cytomegalovirus reactivation, uremia, or infections ( 3 ). Other factors involved are surgical approach and delayed removal of the chest tubes which may precipitate Dressler syndrome.…”

“…Logan et al. ( 3 ) describe surgical technique of the lung transplantation where they entered the pericardium before cardiopulmonary bypass. Disruption of the pericardium in addition to delayed chest closure may have precipitated a strong inflammatory reaction.…”