Effusive-constrictive pericarditis: current perspectives

Abstract

Effusive-constrictive pericarditis (ECP) is defined by concurrent pericardial effusion and pericardial constriction. Whereas the pericardial cavity is typically obliterated in patients with constrictive pericarditis without any effusion, in patients with ECP the scarred pericardium not only constricts the cardiac volume but can also put pericardial fluid under increased pressure, leading to signs suggestive of cardiac tamponade. These hemodynamic features can persist even after the pericardial effusion is removed. The underlying pathogenetic process predominantly involves the visceral pericardium or epicardium. It combines visceral pericardial constriction with pericardial inflammation. Its etiology may be as variable as the causes of effusive or constrictive pericardial disease, which may be infective (e.g., bacterial or viral), malignant or autoreactive. The label idiopathic ECP should be avoided and restricted to only those cases in whom, after thorough clinical and pathological workup including PCR for microbial agents in pericardial fluid and cardiac tissue from peri-and epicardial or endomyocardial biopsies and the assessment of autoimmune processes, no definite diagnosis can be made. Since a considerable number of ECP patients have an inflammatory and reversible pericardial reaction, they can improve under causal and/or anti-inflammatory treatment. The treatment should therefore be based first on eradicating the underlying etiological factors. If such a treatment course remains ineffective, pericardiectomy including the removal of the visceral pericardium is the remaining therapeutic option.

Unilateral Transudative Pleural Effusion due to rare Cause – A Case Report

“…Effusive constrictive pericardial effusion is characterized by concurrent pericardial effusion and constricted pericardium. [8] A common presentation of CP is congestive heart failure. [9] Common causes of constrictive pericarditis include tuberculous (46.8%), [10,11] post-cardiac surgery, [12] radiation, [10,12] uremia, [10] post-traumatic, [10] and idiopathic.…”

Cardio-Immunology of Myocarditis: Focus on Immune Mechanisms and Treatment Options

“…The biopsy findings in these patients fit into these histopathological categories. The inflammasome is a platform in cells of the innate immune system allowing transition from the innate to the adaptive anticardiac immune response directed against myocardial and pericardial targets (11, 46, 62). The proinflammatory cascade in inflammasomes can be terminated intrinsicly, for example by Caspase-1 self-cleavage (63).…”

Not So Transient Effusive-Constrictive Pericarditis

“… 1 Transthoracic echocardiography can show a pericardial effusion, respirophasic septal shift, inferior vena cava dilation with plethora, exaggerated respiratory variation of mitral and tricuspid valve inflow velocities, and annulus reversus. 2 Cardiac magnetic resonance can show increased signal intensity on T2 short tau inversion recovery and late gadolinium enhancement imaging indicative of pericardial edema and inflammation. 2 Cardiac catheterization can show equalization of diastolic pressures, as well as persistent elevation of right atrial pressure following pericardiocentesis.…”

“… 2 Cardiac magnetic resonance can show increased signal intensity on T2 short tau inversion recovery and late gadolinium enhancement imaging indicative of pericardial edema and inflammation. 2 Cardiac catheterization can show equalization of diastolic pressures, as well as persistent elevation of right atrial pressure following pericardiocentesis. 2 Anti-inflammatory medications are curative in almost all cases, and pericardiectomy is pursued in cases that persist despite medical treatment.…”

“… 2 Cardiac catheterization can show equalization of diastolic pressures, as well as persistent elevation of right atrial pressure following pericardiocentesis. 2 Anti-inflammatory medications are curative in almost all cases, and pericardiectomy is pursued in cases that persist despite medical treatment. 2 In this case, the Waffle procedure was employed in which the pericardium is incised longitudinally and transversally where the risk of coronary injury is high.…”