Clinical Pearl

Constrictive pericarditis, if symptomatic and moderate-severe, is a relative contraindication for liver transplantation.  It is a disease that hinders ventricular relaxation.  In the case of liver transplantation, cardiac preload is expected to increase significantly (as the new, healthy liver does not resist blood flow).  Right heart failure might ensue.  Consideration should be given for a pericardiectomy/pericardial window placement prior to liver transplant.

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