Constrictive pericarditis after heart transplantation: a case report

Abstract

Background Constrictive pericarditis (CP) is a disease characterized by inflammation, progressive fibrosis, and thickening of the pericardium. Constrictive pericarditis after heart transplantation (HT) is a rare phenomenon, with a reported incidence of 1.4–3.9%. It is an important clinical problem which shares similar clinical features with entities such as restrictive cardiomyopathy. Therefore, it poses diagnostic challenges and therapeutic dilemmas even for experienced clinicians. Case summary A 53-year-old patient developed a zoster infection with pericardial effusion 9 months after HT for idiopathic dilated cardiomyopathy. Two months later, he presented with leg oedema and ascites and was treated by diuretics for volume overload. He was readmitted 8 months later with features of right heart failure. Multimodal imaging investigations were suggestive of CP. He successfully recovered after a radical pericardiectomy. Discussion Constrictive pericarditis is a rare complication in HT. Heart transplant recipients (HTR) with a history of post-operative pericardial effusion, or with rejection episodes are at high risk of developing CP. Differentiating CP from other conditions that cause apparent congestive heart failure in HTR is challenging. Management of CP is mainly surgical pericardiectomy.

Acute graft rejection mimicking constrictive pericarditis after heart transplantation. A case report

“…Extensive case series have delved into the nuances of chronic constrictive pericarditis, providing valuable insights into its varied clinical profiles. However, within the specific context of cardiac transplantation, the available literature is characterized by smaller case series and isolated reports detailing the emergence of constriction post-transplantation 5 , 6 . These instances underscore the unique challenges in recognizing and managing CP in the transplant setting, necessitating a nuanced understanding of its atypical presentations and their association with postoperative events.…”

“…The diagnostic conundrum lies in the challenge of discriminating constrictive pericarditis from various other conditions that can precipitate symptoms of congestive heart failure in heart transplant recipients 5 . This intricacy underscores the need for heightened clinical vigilance and meticulous diagnostic evaluation.…”

“…conditions that can precipitate symptoms of congestive heart failure in heart transplant recipients (5) . This intricacy underscores the need for heightened clinical vigilance and meticulous diagnostic evaluation.…”

Indications, Complications, and Outcomes of Cardiac Surgery After Heart Transplantation: Results From the Cash Study

“…Constrictive pericarditis after HTX is rare and is typically associated with recurrent pericardial effusions, allograft rejection, or biopsy-related complications ( 42 – 44 ). As most of the participating centers did not report any cases of constrictive pericarditis requiring pericardiectomy, we cannot draw conclusions as to whether patients were undiagnosed at some centers and whether surgical and/or treatment strategies differed at the three centers that reported cases of constrictive pericarditis.…”

A Comprehensive Excursus of the Roles of Echocardiography in Heart Transplantation Follow-Up

“…Although these effusions rarely evolve into cardiac tamponade, frequent echocardiographic assessments are warranted, in order to detect extension and hemodynamic impact. Moreover, even the occurrence of hemodynamically irrelevant pericardial effusion is associated with an increased risk of hospitalization and mortality [ 31 ] and may in rare occasions lead to the development of constrictive pericarditis [ 32 ].…”