Early pneumopericardium after heart transplantation

Abstract

A 60-year-old woman with a history of dilated cardiomyopathy underwent heart transplantation. One month post discharge, she presented to clinic with low-grade fever and productive cough. Her chest radiograph showed air-fluid levels in the pericardial silhouette. Transthoracic echocardiogram showed a large complex pericardial collection with no evidence of cardiac tamponade. The patient was urgently taken to the operating room for exploration. A large "egg-shaped" mass in the pericardium measuring 10 × 12 cm with gaseous material was aspirated. As the posterior wall of the mass was firmly adhered to the right atrium, the capsule was incompletely excised. We present the case of a potentially life-threatening complication post transplantation that required surgical debridement and life-long antibiotic suppressive therapy. To our knowledge, this is the first report of purulent pericardial collection caused by Enterobacter cancerogenous. Further research is required to better understand the biology of this microorganism and the role it may play as a pathogen in immunocompromised patients following solid organ transplantation.

Early Postoperative Cardiac Complications Following Heart Transplantation

“…Moreover, younger ages, as well as history in the use of ventilator and ECMO were acompanied by higher risks of infection causing high mortality rates [64]. In addition, a case report showed that Enterobacter cancerogenous could be identified in heart transplant recipients leading to early pneumopericardium [65]. Severe gastroparesis is a rare condition that could be diagnosed in recipients of orthotopic heart transplantation leading to significant morbidity, including vomiting, aspiration, and pneumonia [66].…”