Indications, results, and pitfalls in the surgery of constrictive pericarditis

Constrictive pericarditis is a rare disease with an often unclear etiology. There may be a long delay between the onset of the underlying disease and the onset of clinical symptoms, which are fatigue, abdominal swelling, peri pheral edema and breathlessness. However, if clinically apparent, these sym ptoms may progress rapidly and severely disable the affected patient. Diagn osis is achieved by the clinical presentation, echocardiography and/or MRI and right heart catheterization. The standard therapy is an extended pericardiectomy to restore an unlimited inflow and outflow as well as an unrestricted diastolic function of both v entricles. The risks of this procedure are related to dense adhesions betwe en the 2 pericardial layers and severe calcifications especially of the epi cardium. Incomplete removal results in persistent diastolic restriction whi le lacerations of the underlying myocardium may lead to diffuse and extensi ve bleeding and finally to myocardial dysfunction. Also, the postoperative course may be complicated by persistent low output syndrome or acute ventri cular dilatation. However, early surgical intervention in the hands of expe rienced surgeons offers the best prognosis.