Constrictive pericarditis: diagnosis, management and clinical outcomes

Abstract

Constrictive pericarditis (CP) is a form of diastolic heart failure that arises because an inelastic pericardium inhibits cardiac filling. This disorder must be considered in the differential diagnosis for unexplained heart failure, particularly when the left ventricular ejection fraction is preserved. Risk factors for the development of CP include prior cardiac surgery and radiation therapy, but most cases are still deemed to be idiopathic. Making the diagnosis may be challenging and requires meticulous echocardiographic assessment, often supplemented by cross-sectional cardiac imaging and haemodynamic catheterisation. The key pathophysiological concepts, which serve as the basis for many of the diagnostic criteria, remain: (1) dissociation of intrathoracic and intracardiac pressures and (2) enhanced ventricular interaction. Complete surgical pericardiectomy is the only effective treatment for chronic CP. A subset of patients with subacute inflammatory CP, often identified by cardiac MRI, may respond to anti-inflammatory treatments.

Predictors of postoperative complication and prolonged intensive care unit stay after complete pericardiectomy in tuberculous constrictive pericarditis

“…Because of the inflammatory disorder and fibrosis, pericardium becomes inelastic gradually and then inhibits the cardiac filling. This process leads to the diastolic heart failure in the end with unfavorable clinical outcome [12] . Early surgical intervention was reported to play a positive role in reducing mortality rate [13,14] , but the diagnosis seems to be challenging in the early stage.…”

The effect of colchicine on the echocardiographic constrictive physiology after coronary artery bypass graft surgery

“…Regarding the effect of inflammation and oxidative stress in the development of constrictive physiology and the fact that duration of ischemic period in cardiac surgery and the inflammatory responses of damaged cells result in both increment in the level of inflammatory and oxidative stress markers. suppression of oxidative and inflammatory systems is an acceptable strategy to prevent cardiac damage and also to prevent constrictive physiology . Although several studies are recommending administration of anti‐inflammatory and antioxidant drugs like colchicine for prevention of constrictive pericarditis, no study has been conducted on the effect of colchicine prophylaxis on constrictive physiology yet.…”

“…suppression of oxidative and inflammatory systems is an acceptable strategy to prevent cardiac damage and also to prevent constrictive physiology. 8,9 Although several studies are recommending administration of anti-inflammatory and antioxidant drugs like colchicine for prevention of constrictive pericarditis, 10 no study has been conducted on the effect of colchicine prophylaxis on constrictive physiology yet. The aim of this study is to evaluate the preventive effect of colchicine on the incidence of echocardiographic constrictive physiology after CABG surgery.…”

A visually striking calcific band causing monomorphic ventricular tachycardia as a first presentation of constrictive pericarditis

“…Tuberculosis remains a leading cause in developing areas. 1 Most commonly, CP presents with symptoms of heart failure and chest discomfort. Atrial arrhythmias have been described as a rare presentation, but arrhythmias of ventricular origin have not been reported.…”