Heart of glass: Constrictive pericarditis

The manuscript highlights: - The aetiology and clinical presentation of patients with constrictive pericarditis. - Pathognomonic invasive haemodynamic findings seen in constrictive pericarditis. - Multi-modality imaging findings that accurately diagnose constrictive pericarditis. - The value of multi-modality imaging in surgical planning and risk stratification. Constrictive pericarditis (CP) refers to a thickened, scarred, and non-compliant pericardium resulting from chronic inflammation of the visceral and or parietal pericardium. In the developed world the commonest causes are idiopathic pericarditis, prior cardiac surgery, and exposure to prior radiotherapy. In the developing world post-tuberculosis remains an important cause. In CP , the pathological hallmark is fibrous thickening and calcification of the pericardium. Although in the early stages only focal changes may be seen with little physiological impact, as the condition progresses, and more extensive pericardial involvement develops, intracardiac physiology is altered and symptoms ensue. Early diagnosis of CP remains important since 30-day mortality is substantially lower in patients undergoing surgical pericardiectomy before NYHA Class III/IV symptoms develop. In the current manuscript we present a prototypical case of CP to facilitate a focused review of this condition along with its characteristic physiological, multimodality imaging and pathological findings. We furthermore detail the surgical approaches to its treatment.