Department of Medicine, School of Medicine, Duke University, Durham, NC.
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
Transplantation. 2020 May;104(5):1081-1084. doi: 10.1097/TP.0000000000002943.
Constrictive pericarditis is a rare, but increasingly recognized long-term postoperative complication of lung transplantation. Heightened clinical suspicion, improved diagnostic imaging, and effective surgical treatment of the disease have led to progressive awareness of the pathology. We present our institutional experience with constrictive pericarditis after lung transplant in an effort to investigate the cause and natural history of the disease.
From October 2005 to October 2018, 1234 patients underwent orthotopic lung transplantation at Duke University Hospital. An institutional database was queried to identify incident patients and determine baseline clinical data. At a median of 11.2 months (interquartile range = 4.6-28.6 mo), 10 patients (0.8%) developed constrictive pericarditis. Simple descriptive statistics were used to describe cohort characteristics and identify variables associated with constrictive pericarditis after lung transplantation.
The indication for transplantation at index operation was idiopathic pulmonary fibrosis in 8 of 10 patients (1.2% of the 760 restrictive lung disease patients transplanted in the same time period). All 10 patients presented with worsening dyspnea and pleural effusions. Right heart catheterization confirmed constrictive physiology in all cases. Eight patients underwent pericardiectomy with improvement in cardiovascular hemodynamics and resolution of symptoms with no 30-day mortality.
Diagnosis of constrictive pericarditis should be considered in patients with new-onset heart failure symptoms or recurrent pleural effusions within 2 years of lung transplantation. Idiopathic pulmonary fibrosis may be associated with increased risk for constrictive pericarditis. Pericardiectomy is a safe and effective treatment for posttransplant constrictive pericarditis.
缩窄性心包炎是肺移植后一种罕见但越来越被认识到的长期术后并发症。临床怀疑程度的提高、诊断成像的改善以及对该疾病的有效手术治疗，使得人们对这种疾病的认识不断加深。我们介绍了我们机构在肺移植后缩窄性心包炎方面的经验，旨在探讨该疾病的病因和自然病史。
从 2005 年 10 月至 2018 年 10 月，杜克大学医院共有 1234 例患者接受了原位肺移植。通过机构数据库查询确定了发病患者并确定了基线临床数据。在中位数为 11.2 个月（四分位距=4.6-28.6 个月）时，有 10 例（0.8%）患者发生了缩窄性心包炎。采用简单描述性统计方法描述队列特征，并确定与肺移植后缩窄性心包炎相关的变量。
10 例患者中有 8 例（1.2%的同期接受移植的 760 例限制性肺疾病患者）的移植指征为特发性肺纤维化。所有 10 例患者均表现为呼吸困难加重和胸腔积液。所有病例均经右心导管检查证实存在缩窄性生理。8 例患者接受了心包切除术，心血管血液动力学得到改善，症状得到缓解，无 30 天死亡率。
在肺移植后 2 年内出现新发心力衰竭症状或复发性胸腔积液的患者，应考虑缩窄性心包炎的诊断。特发性肺纤维化可能与缩窄性心包炎的风险增加有关。心包切除术是治疗移植后缩窄性心包炎的安全有效方法。
