Title : Constrictive pericarditis following lung transplantation: A rare cardiovascular complication in idiopathic pulmonary fibrosis
Abstract:
Constrictive pericarditis is an uncommon but serious complication of lung transplantation, marked by pericardial fibrosis and impaired diastolic filling. It can lead to significant morbidity if not recognized and treated early. This case highlights a rare instance of constrictive pericarditis in a patient with idiopathic pulmonary fibrosis (IPF) following bilateral lung transplantation. A 55-year-old male with idiopathic pulmonary fibrosis (IPF) underwent an uneventful bilateral lung transplantation. Postoperative recovery was smooth, with the patient receiving standard immunosuppressive therapy, including tacrolimus, mycophenolate mofetil, and prednisone.
Four months post-transplant, the patient began experiencing recurrent bilateral pleural effusions of transudative etiology. Initial management included pleural fluid drainage on two occasions, diuresis, and subsequent discharge. Echocardiographic assessments during this period showed normal cardiac function with no evidence of myocardial weakness, stiffness, or heart failure. Despite treatment, the effusions recurred alongside pedal edema, but right heart failure was not evident. Repeat pleural fluid analysis confirmed transudative effusion, and echocardiography remained unremarkable. Given the persistent symptoms, the patient was discussed in a multidisciplinary meeting, leading to a recommendation for right heart catheterization. Hemodynamic studies revealed equalization of pressures, indicative of constrictive pericarditis. Cardiac MRI further supported this diagnosis, identifying significant pericardial thickening.
The patient was initiated on colchicine (BID dosing initially, later reduced to daily) and diuretics, which provided temporary symptomatic relief. However, over time, the patient experienced worsening shortness of breath, increasing pedal edema, and a decline in pulmonary function tests (PFTs). Investigations ruled out lung transplant rejection or infectious complications. Due to failure of medical therapy, the patient was referred for surgical pericardiectomy. The procedure was performed successfully, with intraoperative findings of thickened, adherent pericardium. Postoperatively, the patient demonstrated marked clinical improvement, with resolution of symptoms, enhanced PFTs, and normalization of hemodynamic parameters. The patient was discharged off colchicine and continued on maintenance immunotherapy.
During follow-up in the transplant clinic, the patient remained stable with decreased diuretic requirements. Repeat echocardiography and right heart catheterization confirmed significant improvement in cardiac pressures, consistent with resolution of constrictive pericarditis. Constrictive pericarditis, though rare in lung transplant recipients, should be considered in unexplained heart failure. Prompt imaging, including MRI and catheterization, and timely surgery can improve outcomes. This case highlights the need for early recognition to prevent delays and ensure recovery.
