Effusive-constrictive pericarditis: current perspectives

Effusive-constrictive pericarditis (ECP) is defined by concurrent pericardial effusion and pericardial constriction. Whereas the pericardial cavity is typically obliterated in patients with constrictive pericarditis without any effusion, in patients with ECP the scarred pericardium not only constricts the cardiac volume but can also put pericardial fluid under increased pressure, leading to signs suggestive of cardiac tamponade. These hemodynamic features can persist even after the pericardial effusion is removed. The underlying pathogenetic process predominantly involves the visceral pericardium or epicardium. It combines visceral pericardial constriction with pericardial inflammation. Its etiology may be as variable as the causes of effusive or constrictive pericardial disease, which may be infective (e.g., bacterial or viral), malignant or autoreactive. The label idiopathic ECP should be avoided and restricted to only those cases in whom, after thorough clinical and pathological workup including PCR for microbial agents in pericardial fluid and cardiac tissue from peri- and epicardial or endomyocardial biopsies and the assessment of autoimmune processes, no definite diagnosis can be made. Since a considerable number of ECP patients have an inflammatory and reversible pericardial reaction, they can improve under causal and/or anti-inflammatory treatment. The treatment should therefore be based first on eradicating the underlying etiological factors. If such a treatment course remains ineffective, pericardiectomy including the removal of the visceral pericardium is the remaining therapeutic option.