Abstract
The pericardium is a protective cardiac biologic tissue. The pericardial structure consists of an avascular, double-walled sac containing two layers: the visceral pericardium, which is a thin layer comprising an inner serous monolayer and pericardial physiologic fluid, and the parietal pericardium, which consists of an outer fibroelastic layer. There are two pericardial sinuses: transverse and oblique. The pericardium serves important ligamentous, membranous, metabolic, reflexive, and mechanical functions that are described within the text of this chapter. Constrictive pericarditis is a serious cardiac pathologic process with profound clinical and hemodynamic implications. In constrictive pericarditis, chronic fibrous tight thickening of the pericardial tissue develops secondary to inflammation. As a result, the pericardial elasticity and compliance are adversely effected, in a process that severely impairs cardiac physiology. Clinically, constrictive pericarditis commonly presents with a picture of right-sided heart failure including symptoms of fatigue, exertional dyspnea, and peripheral edema. Associated left cardiac chambers dysfunction also presents as pulmonary congestive symptoms, chest pain, palpitations, abdominal symptoms, and frank anasarca. The unique physical examination findings when this pathology is encountered are delineated in this chapter. The diagnosis of constrictive pericarditis involves physical examination, electrocardiography, chest radiography, and echocardiography. Further evaluation and confirmation include cardiac imaging with computed tomography, magnetic resonance, and, when indicated, right and left heart catheterization.
Definitive surgical management is commonly performed through pericardiectomy. This operation remains technically challenging and its various approaches, challenges, and complications are described. Long-term survival after pericardiectomy is largely dependent on etiology and on patient comorbidities such as older age, New York Heart Association (NYHA) class, renal dysfunction, pulmonary hypertension, increased Child-Pugh liver disease, previous chest irradiation, and hyponatremia. Postoperatively, most patients exhibit improved hemodynamic condition, improved cardiac function, and become symptom free providing that accurate pre-op assessment, adequate patient selection, and timely surgical intervention are performed.