Transient Constrictive Pericarditis
Transient Constrictive Pericarditis
Constrictive pericarditis (CP) is caused by reduction in the elasticity of the pericardium resulting in impaired diastolic filling of the heart. All types of CP were thought to be irreversible in the past. This led to a belief that all patients with CP should undergo pericardiectomy. However, at present, it is well established that selected patients can be treated without pericardiectomy, leading to the concept of transient CP. Clinical improvement can be spontaneous or accomplished with empirical medical therapy administered for several months. As for chronic form, transient CP may not be recognized due to the difficulty in establishing the diagnosis because of the absence of any single method that is 100% sensitive and specific. It is worth considering the possibility of transient type when constrictive physiology is detected by noninvasive methods because correct diagnosis may prevent the inflamed pericardium from becoming the chronic fibrotic type that can be associated with more serious consequences including pericardiectomy.
Constrictive pericarditis (CP) is an important cause of right and/or left ventricular (RV/LV) failure caused by a reduction in the elasticity of the pericardium resulting in impaired diastolic filling of the heart. All types of CP were thought to be irreversible until 1987. At present, it is known that selected patients can be treated with medical therapy, leading to the concept of transient CP (Figure 1). However, there are some differences between transient and chronic CP (Table 1).
(Enlarge Image)
Figure 1.
Computerized tomographic imaging of transient constrictive pericarditis. (A) Thickened pericardium (arrows) in the acute phase of idiopathic/viral pericarditis. Asterisk indicates accompanying pericardial effusion.
(B) Pericardium at normal thickness after a trial of medical treatment for 4 months.
Abstract and Introduction
Abstract
Constrictive pericarditis (CP) is caused by reduction in the elasticity of the pericardium resulting in impaired diastolic filling of the heart. All types of CP were thought to be irreversible in the past. This led to a belief that all patients with CP should undergo pericardiectomy. However, at present, it is well established that selected patients can be treated without pericardiectomy, leading to the concept of transient CP. Clinical improvement can be spontaneous or accomplished with empirical medical therapy administered for several months. As for chronic form, transient CP may not be recognized due to the difficulty in establishing the diagnosis because of the absence of any single method that is 100% sensitive and specific. It is worth considering the possibility of transient type when constrictive physiology is detected by noninvasive methods because correct diagnosis may prevent the inflamed pericardium from becoming the chronic fibrotic type that can be associated with more serious consequences including pericardiectomy.
Introduction
Constrictive pericarditis (CP) is an important cause of right and/or left ventricular (RV/LV) failure caused by a reduction in the elasticity of the pericardium resulting in impaired diastolic filling of the heart. All types of CP were thought to be irreversible until 1987. At present, it is known that selected patients can be treated with medical therapy, leading to the concept of transient CP (Figure 1). However, there are some differences between transient and chronic CP (Table 1).
(Enlarge Image)
Figure 1.
Computerized tomographic imaging of transient constrictive pericarditis. (A) Thickened pericardium (arrows) in the acute phase of idiopathic/viral pericarditis. Asterisk indicates accompanying pericardial effusion.
(B) Pericardium at normal thickness after a trial of medical treatment for 4 months.
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