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Effusive Constrictive Pericarditis
Effusive constrictive pericarditis is the least common of the pericardial constraint syndromes. It is defined as the persistence of elevated intracardiac pressure after pericardiocentesis for pericardial tamponade. It was first recognized in the 1920s and 1930s when surgical pericardiectomy became an established therapy for constrictive pericarditis. The syndrome combines elements of pericardial effusion or tamponade with a visceral constrictive pericarditis. ,
Epidemiology
The prevalence of effusive constrictive pericarditis differs based on presentation. It has been reported to be present in 1.3% of patients with pericarditis. In those presenting with pericardial effusions, the prevalence was 1.4% to 3.6%, , and for those who present with tamponade, it was as high as 6.9% to 7.9%. , In one surgical series, 24% of patients requiring pericardiectomy for constrictive pericarditis had effusive constrictive pericarditis. Given that many of these numbers come from patients who underwent left and right heart catheterizations, they may underestimate the true prevalence of effusive constrictive pericarditis. In a recent study, the incidence of constrictive physiology on postpericardiocentesis echocardiography Doppler examination was 16.1%. This suggests that the actual incidence may be considerably higher than previously thought.
Cause
The cause of effusive constrictive pericarditis greatly depends on the geographic location. In areas where tuberculosis is endemic, it is responsible for the vast majority of pericardial disease, such as in South Africa, where 70% of pericardial effusions are tuberculous. The incidence of effusive constrictive pericarditis in patients with tuberculous pericarditis in endemic areas was found to be 2.6% to 15%. In one study, in which invasive measurements were used during the drainage of tuberculous pericardial effusions, 38% met the hemodynamic criteria for effusive constrictive pericarditis. This is in contrast to the findings in Western countries, where tuberculosis is far less prevalent. In these geographic regions, findings mirror other pericardial diseases in which a broad spectrum of causes are reported, with idiopathic being the most common. However, in contrast to chronic noneffusive constrictive pericarditis, radiation-related and malignancy-related causes occur more frequently than after pericardiotomy. ,
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