Constrictive pericarditis surgery
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Constrictive Pericarditis Microchapters |
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Differentiating Constrictive Pericarditis from other Diseases |
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Treatment |
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Constrictive pericarditis surgery On the Web |
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American Roentgen Ray Society Images of Constrictive pericarditis surgery |
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Risk calculators and risk factors for Constrictive pericarditis surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor in Chief: M.Umer Tariq [2]; Hafiz M. Ahmed, M.D.[3]
Overview
Surgical pericardiectomy is the definitive treatment for noninflammatory constrictive pericarditis and for inflammatory constrictive pericarditis that does not respond adequately to anti-inflammatory therapy. When active pericardial inflammation is present, anti-inflammatory therapy should generally be attempted before surgery, because transient constrictive physiology may improve and inflammation reduction may facilitate subsequent surgery if pericardiectomy remains necessary.
Surgery
- Radical surgical pericardiectomy is recommended for noninflammatory constrictive pericarditis and for inflammatory constrictive pericarditis that fails anti-inflammatory therapy.
- Surgical radical pericardiectomy should remove the entire pericardium, including the anterior, diaphragmatic, and posterior pericardial segments, and is generally performed on cardiopulmonary bypass.
- Pericardiectomy should be performed at experienced tertiary surgical centers to optimize clinical outcomes.
- Partial anterior and/or diaphragmatic pericardiectomy is not recommended for constrictive pericarditis.
- In patients with transient or inflammatory constrictive pericarditis, anti-inflammatory therapy may resolve constrictive pathophysiology or reduce inflammation before surgery if pericardiectomy remains indicated.[1]
Preoperative evaluation
- Transthoracic echocardiography is recommended for noninvasive hemodynamic assessment of constrictive pericarditis.
- Cardiac magnetic resonance imaging is recommended to identify pericardial inflammation as a potentially reversible cause of constrictive physiology.
- Cardiac computed tomography may be useful to identify pericardial calcification and to define thoracic anatomy before pericardiectomy.
- Invasive cardiac catheterization is recommended when noninvasive diagnostic methods are nondiagnostic or equivocal.[1]
References
- ↑ 1.0 1.1 Wang TKM, Klein AL, Cremer PC, Imazio M, Kohnstamm S, Luis SA, Mardigyan V, Mukherjee M, Ordovas K, Vakamudi S, Wohlford GF. 2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on the Diagnosis and Management of Pericarditis: A Report of the American College of Cardiology Solution Set Oversight Committee. Journal of the American College of Cardiology. 2025;86(25):2691-2719. https://doi.org/10.1016/j.jacc.2025.05.023.