Constrictive Pericarditis: A Comprehensive Overview

Visual Abstract 1. Constrictive pericarditis presentation, etiology, manifestation, diagnoses and management

Figure 1. Echocardiographic findings in constrictive pericarditis, (a) A four-chamber view of the heart showing an abrupt early diastolic displacement of the interventricular septum (also known as a septal bounce). The patients also has moderate pericardial thickening and localized pericardial effusion, (b) A short-axis view of the heart echocardiography demonstrating pericardial thickening, calcification, and significant respirophasic septal shift with an early diastolic septal bounce, (c) Demonstrates pericardial calcification (arrow heads), (d) Demonstrates mitral inflow respirophasic variation, characterized by >25% variation in early diastolic (E-wave) velocity with respiration – a hallmark finding suggestive of constrictive physiology

Figure 2. Cardiac magnetic resonance imaging findings in constrictive pericarditis, (a) Demonstrates constrictive-effusive pericarditis with significant pericardial thickening and effusion (arrows). Bilateral pleural effusion is also noted (arrow heads). Compared with echocardiography, magnetic resonance imaging (MRI) is better in detecting smaller pericardial effusions. The pericardial enhancement in noncontrasted sequences is proportional to the degree of active pericardial inflammation, (b) Demonstrates significant early diastolic septal bounce and pericardial thickening. A left pleural effusion is noted, (c) Demonstrates significant pericardial late gadolinium enhancement (arrows), a sign of pericardial fibrosis, (d) Cardiac MRI tagging using the spatial modulation of magnetization (SPAMM) sequence technique. SPAMM tagging occurs during diastole. The dark lines forming the special matrix normally appear discontinued (fractured) at points where the visceral and parietal pericardium slide against each other during systole. However, when both pericardial layers are fused due to inflammation and fibrosis, the discontinuation of lines is lost as the two layers move jointly

Figure 3. Right and left ventricular hemodynamics in constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM). In CP, early rapid ventricular filling is associated with a characteristic “square root” or “dip-and-plateau” configuration of the right ventricular (RV) pressure waveform (arrow). A hallmark feature of CP is discordant respirophasic changes in systolic pressures between the left and right ventricles–RV systolic pressure increases during inspiration while LV systolic pressure decreases. In contrast, RCM is typically associated with concordant changes in LV and RV systolic pressures with respiration and lacks the dip-and-plateau pattern