Constrictive pericarditis: A medical or surgical disease?

Constrictive pericarditis is a disease of the pericardium resulting from chronic inflammation and/or scar responsible for a clinical feature of left and right ventricular failure. Although constrictive pericarditis has long been considered a surgical disease, a subset of patients experience reversibility of pericardial inflammation, a condition referred to as “transient constriction.” Thus, after establishing the diagnosis of constrictive pericarditis, it is essential to evaluate the duration and potential for reversal to determine an appropriate treatment plan. Evidence of chronic disease can be acquired from the patient's clinical features and cardiac imaging, especially calcifications seen on computed tomography and chest X-ray. Transient constrictive pericarditis should be considered in cases without evidence of chronic disease, as active inflammation of the pericardium can be treated medically. Resolution of constrictive physiology can be evaluated using serial transthoracic 2-D Doppler echocardiography along with clinical examination. The potential for reversibility may also be assessed with multi-modality cardiac imaging to look for evidence of late enhancement on cardiac magnetic resonance and¹⁸F-FDG PET/CT imaging.