Constrictive Pericarditis

Abstract

Patients with untreated constrictive pericarditis sooner or later have ascites, edema, and pleural effusions. Unless these are treated, the patient soon becomes bedridden. Treatment with a low-sodium diet, diuretics, and aspiration often allows a patient to live a semi-invalid life for 5 to 15 years and occasionally to survive to old age. However, the general tendency is toward gradual deterioration despite treatment. The course in children and young adults is more rapid and the effects of medical treatment less effective. Pericardiectomy abolishes or greatly improves symptoms and signs in 60 to 85% of patients; the benefits are long lasting; and life expectation is increased. The operative mortality is in the range of 4 to 20%. Persistence of symptoms and signs after operation is attributable to one of the following factors: delayed hemodynamic adjustment, imperfect surgical relief, or myocardial changes. These changes may be the result of myocardial atrophy, other degenerative myopathies, or associated disease. After an effective pericardiectomy, the hemodynamic fault may be completely corrected, but some residual abnormality can persist with symptomatic improvement. The electrocardiogram may improve, become completely normal, or remain unchanged; while electrocardiographic improvement is invariably associated with clinical improvement, the latter may occur despite persistence of an abnormal electrocardiogram. The heart size usually diminishes. Protein-losing gastroenteropathy is completely cured or greatly improved.