Constrictive Pericarditis: Old Disease, New Approaches

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.