THE PERICARDIUM AND CARDIAC TRANSPLANTATI ON

The authors emphasise the role of the pericardium in the postoperative complications of cardiac transplantation : its role is as important a s it is underestimated in its frequency, severity and the pathogenic d iscussions that it induces. This study, based on a retrospective analy sis of 191 anatomo-clinical cases (156 autopsies and 35 retransplantat ions) of patients undergoing cardiac transplantation before the 1/03/1 993 including macroscopic and histopathologic analysis of the pericard ial lesions, histochemical analysis of the lymphocytic populations, an d analysis of associated coronary and myocardial lesions. The results were classified as early or late (after the 75th postoperative day) co mplications. Early complications included 27 suppurating mediastino-pe ricarditis (13 aspergillosis and 14 bacterial), 16 autonomous non-infe ctive pericardial complications (6 haemopericardiums, 6 organised comp ressive haematomas, 4 early constrictive pericarditis) and 9 lymphocyt ic epicarditis associated with acute myocardial rejection. Late compli cations included one common constrictive symphysis and 14 reactivated epicarditis associated with transplantation coronary disease (chronic rejection) with associated lymphoplasmocytic nodules and a myocardial vasculitis. These observations suggest two important conclusions : 1) the need for active diagnostic measures to detect pericardial complica tions in cases of cardiac transplant dysfunction in the early postoper ative period with no signs of acute rejection on myocardial biopsy : t he presence of epicardial lesions on biopsy should be taken into accou nt and not just assumed to be a postoperative epiphenomenon ; 2) the p resence of epicarditis due to reactivated epicarditis may cause inexte nsible hardening of the epicardium which adds to the effects of restri ctive cardiomyopathy of chronic rejection.