|Year : 2015 | Volume
| Issue : 2 | Page : 104
Constrictive pericarditis: A disease which refuses to go away!
S Seth, Shyam S Kothari
Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
|Date of Web Publication||30-Sep-2015|
Shyam S Kothari
Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Seth S, Kothari SS. Constrictive pericarditis: A disease which refuses to go away!. J Pract Cardiovasc Sci 2015;1:104
Described first, 300 years ago as concretio cordis, constrictive pericarditis is a disease which has not shown a decrease in incidence with socioeconomic development, unlike other diseases linked to underdevelopment and inflammation such as rheumatic heart disease, endomyocardial fibrosis, and aortoarteritis which have shown a declining trend. We are no closer to understanding the pathogenesis of constrictive pericarditis. In India, we often suspect tuberculosis as the inciting agent, although operated specimens hardly show tuberculosis on histopathology and some of these could be postviral pericarditis as well. In the West, cardiac surgery, radiation, and viral infection are believed to be the etiological factors.
| What Has Changed in the Last Decade?|| |
Clinical diagnosis of chronic constructive pericarditis (CCP) remains as an interesting exercise and is relatively easy in a typical case as discussed in this issue. There are caveats, as always, in the clinical diagnosis of CCP. In the last decade, growing appreciation of Doppler echocardiography, tissue Doppler imaging, computed tomography (CT), and magnetic resonance imaging (MRI) has made the diagnosis of CCP possible without cardiac catheterization with fair degree of certainty. Nevertheless, it is also emerging that CCP is possible with an apparently “not thickened” pericardium on imaging. Role of CT and MRI is discussed by Dr. Priya in this issue.
Medical management of CCP as commonly practiced in India is not evidence-based. Antitubercular therapy is often advised preoperatively in patients without adequate rationale. Role of steroids has been reemphasized in a recent trial which has been reviewed in this issue.
Surgical treatment of CCP is deceptively simple in theory, but in practice, it tests all the surgical acumen and patience of the surgeon. Pericardiectomy should be done by experienced surgeons and not by neophytes. Although the treatment has been standardized, it carries substantial mortality and morbidity and fear of inadequate resection in difficult cases. Reading the history of surgery is interesting. Sommerville's article in 1966, while describing their own series of 56 patients, traces how the mortality was more than 20% before the 50's and then reached to 13% between 1951 and 1961. Sommerville's own series in 1966 showed a mortality of 4%. Though surgical techniques have changed with time, the mortality figures have not reached lower than this figure. More about surgery is in subsequent issues.
In conclusion, CCP continues to fascinate the clinicians. Noninvasive diagnostic testing with Doppler echocardiography and CT, MRI imaging has simplified the diagnosis to a great extent. Surgical treatment is largely curative. Occasional patients still pose a diagnostic challenge where a synthesis of facets is required.
| References|| |
Myers RB, Spodick DH. Constrictive pericarditis: Clinical and pathophysiologic characteristics. Am Heart J 1999;138 (2 Pt 1):219-32.
Deepti S, Gupta SK. A case of right sided heart failure. Journal of the Practice of Cardiovascular Sciences 2015;1:130-37.
Jagia P, Kumar K. Imaging in constrictive pericarditis. Journal of the Practice of Cardiovascular Sciences 2015;1:176-78.
Harikrishna J, Mohan A. Treatment of tuberculosis pericarditis. Journal of the Practice of Cardiovascular Sciences 2015;1:179-81.