Hinkamp T J, Sullivan H J, Montoya A, Park S, Bartlett L, Pifarre R
Loyala University Medical Center, Maywood, Illinois 60153.
Ann Thorac Surg. 1994 Jun;57(6):1579-83. doi: 10.1016/0003-4975(94)90127-9.
The hemodynamic changes consistent with constrictive pericarditis are often encountered in patients who have undergone cardiac transplantation. We describe here 4 patients who underwent pericardiectomy after cardiac transplantation. All were found to have evidence of a thickened and constricting peel of pericardium at surgical exploration. Their postoperative clinical courses were variable. One patient with primarily effusive constriction experienced marked improvement. Three patients failed to show clinical improvement and had persistently elevated atrial and ventricular end-diastolic pressures. A coexisting restrictive cardiomyopathy secondary to chronic rejection, coronary arteriopathy, or long-standing constriction may have been the cause of this poor outcome. Many patients with transplanted hearts exhibit evidence of poor diastolic ventricular compliance without evidence of classic constriction; some manifest both the restrictive and constrictive components. The careful selection of patients with constrictive pericarditis can optimize the outcome.
心脏移植患者常出现与缩窄性心包炎相符的血流动力学变化。我们在此描述4例心脏移植后接受心包切除术的患者。所有患者在手术探查时均发现有增厚且缩窄的心包膜证据。他们术后的临床病程各不相同。1例主要为渗出性缩窄的患者病情明显改善。3例患者未显示临床改善，心房和心室舒张末期压力持续升高。继发于慢性排斥反应、冠状动脉病变或长期缩窄的并存限制性心肌病可能是导致这种不良结局的原因。许多移植心脏的患者表现出舒张期心室顺应性差的证据，但无典型缩窄的证据；有些患者同时表现出限制性和缩窄性成分。仔细选择缩窄性心包炎患者可优化治疗结果。
