Pericarditis, Constrictive

Dense changes in pericardium can be caused by scarring induced by a single episode of acute pericarditis or by prolonged exposure to an inflammatory process.

18% of pericardiectomies are attributed to previous cardiac surgery, which may explain the increase in number of cases of CP since the mid-1990s.

Heart failure, atrial arrhythmia, MI

Abnormal drug metabolism secondary to liver failure

Intraop major hemorrhage

Postop respiratory failure

Hemodynamic instability due to limited filling or myocardial depression.

When providing GA, be prepared for CPB.

Right heart failure and volume overload.

Differentiate from restrictive cardiomyopathy by various signs and symptoms as well as ECHO.

CP is an inflammation of the pericardium, leading to impaired filling of the ventricles and reduced ventricular function.

Restriction of the pericardium results in increased ventricular interdependence and a reciprocal relation between the filling of the left and right heart.

During spontaneous ventilation, transtricuspid blood flow is increased, resulting in increased filling of the RV. This will lead the septum to shift to the left and to decrease LVEDV, with subsequent hypotension and pulsus paradoxus.

During expiration, the septum is shifted to the right. Opposite changes take place during mechanical ventilation.

Pts present with dyspnea, fatigue, orthopnea, and right heart failure with jugular venous congestion and chest pain, hepatomegaly, and ascites.

Cardiac cath with hemodynamic assessment is considered the “gold standard.” However, comprehensive echocardiography with Doppler assessment is usually necessary to confirm CP and exclude restrictive cardiomyopathy.