Anti-inflammatory properties of amniotic membrane patch following pericardiectomy for constrictive pericarditis
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CASE REPORT
Open Access
Anti-inflammatory properties of amniotic membrane patch following pericardiectomy for constrictive pericarditis Katherine M. Marsh1, Alice S. Ferng1, Tia Pilikian1, Ankit A. Desai2, Ryan Avery3, Mark Friedman2, Isabel Oliva3, Clint Jokerst3, David Schipper1 and Zain Khalpey1,3,4,5,6*
Abstract Background: Since constrictive pericarditis is most often idiopathic and the pathophysiology remains largely unknown, both the diagnosis and the treatment can be challenging. However, by definition, inflammatory processes are central to this disease process. Amniotic membrane patches have been shown to possess anti-inflammatory properties and are believed to be immune privileged. Due to these properties, amniotic membrane patches were applied intraoperatively in a complicated patient presenting with constrictive pericarditis. Case presentation: A patient with a history of multiple cardiac surgeries presented with marked fatigue, worsening dyspnea and sinus tachycardia. He was found to have constrictive physiology during cardiac catheterization, with cardiac MRI demonstrating hepatic vein dilatation, atrial enlargement and ventricular narrowing. After amniotic membrane patch treatment and pericardiectomy, post-operative cardiac MRI failed to demonstrate any appreciable pericardial effusion or inflammation, with no increased T2 signal that would suggest edema. Conclusions: Given the positive results seen in this complex patient, we suggest continued research into the beneficial properties of amniotic membrane patches in cardiac surgery. Keywords: Constrictive pericarditis, Amniotic membrane patch, Orthotopic heart transplant
Background Constrictive pericarditis results in a thickened and lesselastic pericardium, which can lead to incomplete diastolic filling and myocardial ischemia [1]. Since it is rare and the presenting symptoms are similar to those of several other disorders, the diagnosis can often be challenging. The diagnosis is usually made using cardiac catheterization or echocardiography as a part of the patient’s initial clinical evaluation. Although there are multiple etiologies of constrictive pericarditis, in most cases, the pathophysiology is idiopathic or may occur following cardiac surgical procedures including orthotopic heart transplant [2]. Constrictive pericarditis * Correspondence: [email protected] 1 Department of Surgery, Division of Cardiothoracic Surgery, University of Arizona College of Medicine, 1501 North Campbell Avenue, Room 4302, Tucson, AZ 85724, USA 3 Department of Medical Imaging, University of Arizona College of Medicine, Tucson, USA Full list of author information is available at the end of the article
is commonly treated with pericardiectomy; however even following surgical intervention, long-term survival decreases over time and further diminishes when patient history includes multiple cardiac re-operations [3]. It has recently been demonstrated that amniotic stem cell therapy consisting of either stem cells with extracellular matrix or extracellular m
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