Management of tuberculous pericarditis

Area of Science:

• Cardiology
• Infectious Diseases
• Thoracic Surgery

Background:

• Tuberculous pericarditis is a significant cause of pericardial effusion and tamponade, particularly in endemic regions.
• Traditional diagnostic and management approaches can lead to delayed recognition and treatment, increasing morbidity.

Purpose of the Study:

• To review the management and outcomes of tuberculous pericarditis patients.
• To evaluate the impact of echocardiography on early diagnosis and prevention of pericardial tamponade.
• To assess the role of surgical interventions in managing tuberculous pericarditis.

Main Methods:

• Retrospective review of 17 patients diagnosed with tuberculous pericarditis.
• Analysis of clinical presentation, diagnostic methods (including echocardiography), treatment strategies, and patient outcomes.
• Evaluation of surgical drainage (pericardial window) and pericardiectomy procedures.

Main Results:

• 13 out of 17 patients presented with effusive pericarditis.
• 10 patients underwent surgical drainage of pericardial effusion.
• No deaths were attributed to pericardial tamponade, likely due to earlier effusion detection via echocardiography.
• Pericardial constriction developed in 2 patients on therapy; pericardial thickening was noted in 2 others post-effusion resolution.

Conclusions:

• Early echocardiographic recognition of major pericardial effusions in tuberculous pericarditis is crucial for preventing tamponade mortality.
• A pericardial window is recommended for initial management of significant effusions.
• Early pericardiectomy should be considered if pericardial thickening is identified during surgical intervention.