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Constrictive pericarditis, still a diagnostic challenge: comprehensive review of clinical management

Markus Schwefer1, Rene Aschenbach, Jan Heidemann

  • 1Helios Klinikum Erfurt, Department of Cardiology, Nordhaeuser Strasse 74, D-99089 Erfurt, Germany.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|April 28, 2009
PubMed

Insights

Diagnosing constrictive pericarditis (CP) remains challenging. Advanced imaging and surgical pericardiectomy offer symptomatic relief, but outcomes depend on the cause and patient factors.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Cardiac Surgery

Background:

  • Constrictive pericarditis (CP) diagnosis is complex, requiring differentiation from restrictive cardiomyopathy.
  • Integrating pathophysiology with invasive and non-invasive data is crucial for accurate diagnosis.

Purpose of the Study:

  • To review current diagnostic challenges and therapeutic strategies for constrictive pericarditis.
  • To highlight the role of novel imaging techniques in diagnosing CP.
  • To discuss factors influencing outcomes after pericardiectomy.

Main Methods:

  • Review of current literature on constrictive pericarditis diagnosis and management.
  • Emphasis on advanced echocardiography (tissue Doppler imaging, 2D-speckle tracking).
  • Inclusion of dual-source CT and tagged cine-MRI with phase contrast angiography.

Main Results:

  • Novel imaging techniques show promise for improved CP diagnosis.
  • Pericardiectomy is the treatment of choice, offering relief in most patients.
  • Factors like etiology, myocardial compliance, and residual constriction impact surgical outcomes.

Conclusions:

  • Accurate diagnosis of CP necessitates integrating advanced imaging and clinical data.
  • Pericardiectomy provides symptomatic benefit, but long-term outcomes are influenced by the underlying cause of pericardial disease.
  • Etiology is a key predictor of survival post-pericardiectomy, with post-radiation CP having the worst prognosis.

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