[Constrictive pericarditis: etiology, diagnostic work-up, and therapy]

Constrictive pericarditis is characterized by a fibrous thickened pericardial layer which prevents the cardiac chambers from regular filling. Today, this disease is often caused by previous cardiac surgery or mediastinal radiotherapy, whereas tuberculosis as a cause is less important nowadays. Due to the reduced diastolic filling the cardiac output is diminished and the veins are engorged. The patients present with ascites, liver congestion, and dilated jugular veins. A pericardial effusion, the ECG or an echocardiography may give first hints for the diagnosis. The chest X-ray examination might detect pericardial calcifications (see Figure 2). Doppler echocardiography and cardiac catheterization, especially during breathing maneuvers, are diagnostic, as they demonstrate the diastolic filling disturbance ("dip-plateau sign", see Figure 1), the equal increase of left and right ventricular end-diastolic and mean atrial pressures, and the strong dependency of ventricular filling from respiration. Computed tomography or magnetic resonance imaging might reveal the thickened pericardial layer (see Figures 3 and 4). The most important differential diagnosis is restrictive cardiomyopathy, which has similar clinical and hemodynamic findings. A comprehensive diagnostic work-up is necessary, as the constrictive pericarditis may be cured by a timely performed pericardial resection.