onstrictive pericarditis, an uncommon disease, is a chronic fibrous thickening of the pericardium that prevents the normal diastolic filling of the heart. Surgery is the only satisfactory treatment. Many factors associated with the development of constrictive pericarditis have been identified, such as infection, post heart surgery, post mediastinal irradiation, but in Western countries the spectrum of etiology has shifted from infection, especially Mycobacterium tuberculosis (Tb), to post heart surgery, although idiopathic causes still predominate. [1][2][3][4] In endemic areas, however, Tb remains the most common cause of constrictive pericarditis. 5,6 Thirteen years experience of constrictive pericarditis patients who underwent total pericardiectomy in a university hospital located in a rural area of Taiwan were reviewed and the clinical characteristics, especially the etiological spectrum, and operative approach were analyzed. MethodsWe retrospectively analyzed the characteristics of 23 patients (19 males, 4 females, age range 25-65 years) who underwent total pericardiectomy for constrictive pericarditis between January 1990 and December 2003. Constrictive pericarditis was diagnosed by chest roentgenography (calcified pericardium), computed tomography scan (thickened pericardium and/or pleural effusion), 7 and confirmed by cardiac catheterization (elevated end-diastolic pressure and classic "square root sign" of right ventricular pressure tracing). 8,9 The etiological factors evaluated included underlying diseases, microbiological culture results, and histopathological findings. Tubercular pericarditis was diagnosed if the histopathological section of pericardium showed the granulomatous changes of Tb. Table 1 shows the clinical characteristics of the study group prior to operation. The most common symptoms were exertional dyspnea (96%), jugular vein distension (96%), hepatomegaly (70%), general fatigue (65%), peripheral edema (65%), and ascites (52%). Pathogens isolated in 11 patients (48%) were Tb in 8 patients (35%) and streptococcus in 2 patients (9%); 1 patient had strongyloidiasis Results Clinical Characteristics and Treatment of Constrictive Pericarditis in TaiwanRobert Fu-Chean Chen, MD; Cha-Po Lai, MD* Background Constrictive pericarditis is an uncommon disease that prevents the normal diastolic filling of the heart and pericardiectomy is the only satisfactory treatment. Methods and ResultsThe clinical characteristics and treatment of patients who underwent pericardiectomy for constrictive pericarditis (n=23) were reviewed. Surgery was performed via left anterolateral thoracotomy plus transsternal extension in 3 patients, and median sternotomy in 20 patients. There were 2 deaths, resulting in an overall mortality rate of 8.7%. Of the 23 patients, 8 had Mycobacterium tuberculosis (Tb) infection, 2 had streptococcus infection, 1 had strongyloidiasis (Strongyloides stercoralis) and 1 developed the condition after a myocardial infarction; 2 patients underwent pericardial substitute insertion as post-hea...