Moderate Pericardial Effusions After Heart Transplant: Do They Require Proactive Intervention?

Abstract

Background: The development of pericardial effusion after heart transplantation occurs in approximately 15% of patients. Post-surgical inflammation as well as use of calcinuerin inhibitors have been associated with these pericardial effusions. It is not uncommon to have moderate pericardial effusions, meaning those that are between 1 and 2 cm in circumferential diameter on echocardiography. It is not known whether pericardial effusions of this magnitude resolves spontaneously or whether they progress to the point of cardiac tamponade requiring pericardiocentesis or pericardial window placement. Methods: Between 2008 and 2012 we evaluated 292 patients within the first 6 months post heart transplant for the development of moderate pericardial effusions and followed their course for the ensuing year. Outcomes were documented as: pericardial effusion resolving without intervention, pericardial effusion persisiting without intervention and pericardial effusion worsening requiring intervention. Results: We found 33 (11.3%) heart transplant patients who had developed moderate pericardial effusion within the first 6 months post-transplant. The average time to detection of pericardial effusion was 22.4 ± 18.4 days. In follow up, 78.8 % had resolution of the pericardial effusion, 9.1% had no change (at 1 year follow up), and 12.1% had worsening of pericardial effusion requiring either pericardiocentesis (3 patients) or pericardial window placement (1 patient) (see table). All patients were given a trial of diuretics to reduce the effect of the pericardial effusion prior to intervention and were initiated with tacrolimus and mycophenolate as immunosuppression.Table: No Caption available.Conclusion: The development of moderate pericardial effusion after heart transplantation resolves in a majority of cases and therefore does not necessarily require proactive invasive intervention. However, close follow up is advised. DISCLOSURES:Patel, J.: Grant/Research Support, Alexion Pharmaceuticals. Chang, D.: Grant/Research Support, Abbott Pharmaceuticals. Esmailian, F.: Grant/Research Support, Transmedics, Inc. Kobashigawa, J.: Grant/Research Support, XDx, Inc., Novartis Pharmaceuticals, Transmedics, Inc.