CHRONIC CARDIAC REJECTION MASKING AS CONSTRICTIVE PERICARDITIS

The hemodynamic changes consistent with constrictive pericarditis are often encountered in patients who have undergone cardiac transplantati on. We describe here 4 patients who underwent pericardiectomy after ca rdiac transplantation. All were found to have evidence of a thickened and constricting peel of pericardium at surgical exploration. Their po stoperative clinical courses were variable, One patient with primarily effusive constriction experienced marked improvement. Three patients failed to show clinical improvement and had persistently elevated atri al and ventricular end-diastolic pressures. A coexisting restrictive c ardiomyopathy secondary to chronic rejection, coronary arteriopathy, o r longstanding constriction may have been the cause of this poor outco me. Many patients with transplanted hearts exhibit evidence of poor di astolic ventricular compliance without evidence of classic constrictio n; some manifest both the restrictive and constrictive components. The careful selection of patients with constrictive pericarditis can opti mize the outcome.