Constrictive pericarditis is a rare complication after lung transplantation (1.6% incidence) that presents with nonspecific symptoms and requires invasive hemodynamic confirmation for diagnosis.
Background: Constrictive pericarditis most commonly occurs after cardiac surgery and has been rarely reported following lung transplantation. Limited data and variable presentations make diagnosis challenging in this population. Methods: We retrospectively reviewed patients who underwent lung transplantation at Mayo Clinic from January 2000 through December 2022. Patients who developed constrictive pericarditis after transplantation were identified. Demographic, echocardiographic, hemodynamic, and surgical data were collected. Results: Among 960 lung transplant recipients, 15 patients (1.6 percent) developed constrictive pericarditis, and 5 (0.5%) required pericardiectomy. Of these 5 patients, mean age at transplantation was 57.9 years, all male, with 4 having undergone bilateral and 1 single-lung transplantation. Constrictive pericarditis developed a median of 8.4 months after transplantation, with a range of 83 days to 5.9 years. All patients presented with dyspnea and pleural effusions; one had ascites. Chronic kidney disease stage 3 or 4 was present in 3 patients. Echocardiography demonstrated a dilated inferior vena cava in 80 percent, pericardial effusion in 60 percent, respirophasic septal shift in 60 percent, and hepatic vein expiratory diastolic flow reversal in 20 percent. Right heart catheterization showed elevated right atrial pressure, a square root sign in 4 patients, and ventricular interdependence in all. Two-year survival after pericardiectomy was 60 percent. Conclusion: Constrictive pericarditis is an uncommon but important complication after lung transplantation. Because symptoms are nonspecific and echocardiography may be limited, diagnosis requires a high index of suspicion and invasive hemodynamic confirmation.
Ahmad et al. (Wed,) studied this question.