A Study of Clinical Profile and Management of Patients with Chronic Constrictive Pericarditis - Our Experience

Introduction: The constrictive Pericarditis is a disabling condition but has a good prognosis if surgery is undertaken in time. Pericarditis can be seen as an effusive disease or progressive cardiac constriction. Patients have number of symptoms due to wide variety of causes. Good results for both effusive and constrictive Pericarditis have been reported by centers using different surgical approaches namely the anteriolateral thoracotomy and median sternotomy. Materials and methods: Data was obtained from review of 25 patients operated for constrictive Pericarditis for a period of 3 years clinical profile. Results: The patient's age ranged from 18 months to 45 years. Male to female ratio is 2:1. The presentation in the majority of cases is fairly typical with exertional dyspnoea Class Ill or 1V ascitis, hepatomegaly, raised JVP, pedal edema and pleural effusion and pericardial effusion. Study spectrum consists of constrictive Pericarditis in 17 (68%) cases, constrictive Pericarditis associated with pericardial effusions in 8 (32%) cases. Constrictive Pericarditis associated with pleural effusions in 5 cases. Pyogenic Pericarditis was present in two cases of which in one case right sided empyema was present. SLE present in 2 cases. Exertional dyspnoea was present in 96%, abdominal distension in 68%, peripheral edema in 32%, general cachexia in 30% orthopnoea in 7% of cases. Signs consist of muscle wasting and cachexia in 70% increased JVP 96%. Hepatomegaly in 92%, distant heart sounds in 88%, Kussamaul's sign 96%, peripheral edema 32%, pericardial knock 56%, pulsus paradoxsus 24% cases. Conclusions: Pericarditis is a curable disease if diagnosed and treated in the early stages. If Pericardectomy is done early it reverts the hemodynamic alterations due to constrictive Pericarditis and also establishes the diagnosis of specific disease like tuberculosis by histopathology.