Skip to main content

Advertisement

SpringerLink
Log in

Constrictive Pericarditis: Old Disease, New Approaches

  • Pericardial Disease (AL Klein, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Constrictive pericarditis is a disorder of cardiac filling caused by an inelastic pericardium. This treatable cause of heart failure should be considered in all patients with unexplained right heart failure symptoms or signs, especially when the left ventricular ejection fraction is preserved. Diagnosing constrictive pericarditis remains challenging, and the most effective tools are designed to identify its unique pathophysiologic mechanisms: dissociation of intrathoracic and intracardiac pressures and enhanced ventricular interaction. The cornerstone of the diagnostic work-up remains comprehensive echocardiography with Doppler, but cross-sectional imaging and invasive hemodynamic assessment may be necessary in some cases. Cardiac MRI is particularly helpful in identifying those patients who may have inflammatory constriction that would resolve with anti-inflammatory therapy. Complete surgical pericardiectomy remains the only definitive treatment for patients with chronic constriction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Robertson R, Arnold CR. Constrictive pericarditis with particular reference to etiology. Circulation. 1962;26:525–9.

    Article  CAS  PubMed  Google Scholar 

  2. Mutyaba AK, Balkaran S, Cloete R et al. Constrictive pericarditis requiring pericardiectomy at Groote Schuur Hospital, Cape Town, South Africa: causes and perioperative outcomes in the HIV era (1990–2012). J Thorac Cardiovasc Surg 2014.

  3. Ling LH, Oh JK, Schaff HV, et al. Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardiectomy. Circulation. 1999;100:1380–6.

    Article  CAS  PubMed  Google Scholar 

  4. Bertog SC, Thambidorai SK, Parakh K, et al. Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy. J Am Coll Cardiol. 2004;43:1445–52.

    Article  PubMed  Google Scholar 

  5. Szabo G, Schmack B, Bulut C, et al. Constrictive pericarditis: risks, aetiologies and outcomes after total pericardiectomy: 24 years of experience. Eur J Cardio-Thoracic Surg: Off J Eur Assoc Cardio-Thoracic Surg. 2013;44:1023–8. discussion 1028.

    Article  Google Scholar 

  6. George TJ, Arnaoutakis GJ, Beaty CA, Kilic A, Baumgartner WA, Conte JV. Contemporary etiologies, risk factors, and outcomes after pericardiectomy. Ann Thorac Surg. 2012;94:445–51.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Imazio M, Brucato A, Maestroni S, et al. Risk of constrictive pericarditis after acute pericarditis. Circulation. 2011;124:1270–5.

    Article  PubMed  Google Scholar 

  8. Talreja DR, Edwards WD, Danielson GK, et al. Constrictive pericarditis in 26 patients with histologically normal pericardial thickness. Circulation. 2003;108:1852–7.

    Article  PubMed  Google Scholar 

  9. Hatle LK, Appleton CP, Popp RL. Differentiation of constrictive pericarditis and restrictive cardiomyopathy by Doppler echocardiography. Circulation. 1989;79:357–70.

    Article  CAS  PubMed  Google Scholar 

  10. Bush CA, Stang JM, Wooley CF, Kilman JW. Occult constrictive pericardial disease. Diagnosis by rapid volume expansion and correction by pericardiectomy. Circulation. 1977;56:924–30.

    Article  CAS  PubMed  Google Scholar 

  11. Ling LH, Oh JK, Breen JF, et al. Calcific constrictive pericarditis: is it still with us? Ann Intern Med. 2000;132:444–50.

    Article  CAS  PubMed  Google Scholar 

  12. Welch TD, Ling LH, Espinosa RE, et al. Echocardiographic diagnosis of constrictive pericarditis: Mayo Clinic criteria. Circ Cardiovas Imaging. 2014;7:526–34. This study provides a blinded assessment of modern echocardiographic criteria for constrictive pericarditis.

    Article  Google Scholar 

  13. Oh JK, Hatle LK, Seward JB, et al. Diagnostic role of Doppler echocardiography in constrictive pericarditis. J Am Coll Cardiol. 1994;23:154–62.

    Article  CAS  PubMed  Google Scholar 

  14. Syed FF, Schaff HV, Oh JK. Constrictive pericarditis—a curable diastolic heart failure. Nat Rev Cardiol. 2014;11:530–44.

    Article  PubMed  Google Scholar 

  15. Boonyaratavej S, Oh JK, Tajik AJ, Appleton CP, Seward JB. Comparison of mitral inflow and superior vena cava Doppler velocities in chronic obstructive pulmonary disease and constrictive pericarditis. J Am Coll Cardiol. 1998;32:2043–8.

    Article  CAS  PubMed  Google Scholar 

  16. Kusunose K, Dahiya A, Popovic ZB, et al. Biventricular mechanics in constrictive pericarditis comparison with restrictive cardiomyopathy and impact of pericardiectomy. Circ Cardiovas Imaging. 2013;6:399–406.

    Article  Google Scholar 

  17. Klein AL, Abbara S, Agler DA, et al. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr. 2013;26:965–1012 e15. This review summarizes the use of multi-modality imaging in constrictive pericarditis.

    Article  PubMed  Google Scholar 

  18. Thavendiranathan P, Verhaert D, Walls MC, et al. Simultaneous right and left heart real-time, free-breathing CMR flow quantification identifies constrictive physiology. J Am Coll Cardiol Img. 2012;5:15–24.

    Article  Google Scholar 

  19. Feng D, Glockner J, Kim K, et al. Cardiac magnetic resonance imaging pericardial late gadolinium enhancement and elevated inflammatory markers can predict the reversibility of constrictive pericarditis after antiinflammatory medical therapy: a pilot study. Circulation. 2011;124:1830–7.

    Article  CAS  PubMed  Google Scholar 

  20. Zurick AO, Bolen MA, Kwon DH, et al. Pericardial delayed hyperenhancement with CMR imaging in patients with constrictive pericarditis undergoing surgical pericardiectomy: a case series with histopathological correlation. J Am Coll Cardiol Img. 2011;4:1180–91.

    Article  Google Scholar 

  21. Vaitkus PT, Kussmaul WG. Constrictive pericarditis versus restrictive cardiomyopathy: a reappraisal and update of diagnostic criteria. Am Heart J. 1991;122:1431–41.

    Article  CAS  PubMed  Google Scholar 

  22. Talreja DR, Nishimura RA, Oh JK, Holmes DR. Constrictive pericarditis in the modern era: novel criteria for diagnosis in the cardiac catheterization laboratory. J Am Coll Cardiol. 2008;51:315–9. This study defined the modern invasive hemodynamic criteria for constrictive pericarditis.

    Article  PubMed  Google Scholar 

  23. Babuin L, Alegria JR, Oh JK, Nishimura RA, Jaffe AS. Brain natriuretic peptide levels in constrictive pericarditis and restrictive cardiomyopathy. J Am Coll Cardiol. 2006;47:1489–91.

    Article  CAS  PubMed  Google Scholar 

  24. Haley JH, Tajik AJ, Danielson GK, Schaff HV, Mulvagh SL, Oh JK. Transient constrictive pericarditis: causes and natural history. J Am Coll Cardiol. 2004;43:271–5.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Terrence D. Welch and Jae K. Oh declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Section of Cardiology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA

    Terrence D. Welch

  2. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, 55905, USA

    Jae K. Oh

  3. Geisel School of Medicine at Dartmouth, Hanover, NH, USA

    Terrence D. Welch

Authors
  1. Terrence D. Welch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jae K. Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jae K. Oh.

Additional information

This article is part of the Topical Collection on Pericardial Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Welch, T.D., Oh, J.K. Constrictive Pericarditis: Old Disease, New Approaches. Curr Cardiol Rep 17, 20 (2015). https://doi.org/10.1007/s11886-015-0576-x

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11886-015-0576-x

Keywords

Search

Navigation