Surgical outcome of constrictive pericarditis

Background: constrictive pericarditis may cause scarring and consequent loss of the normal elasticity of the pericardial sac. It is caused by idiopathic, viral, following cardiac surgery, radiation, connective tissue disorder, postinfectious (tuberculous or purulent pericarditis), or miscellaneous causes (malignancy, trauma, drug-induced, asbestosis, sarcoidosis, and uremic pericarditis). It is mostly presented by shortness of breath (SOB) due to right-sided failure. Surgical procedure is the cornerstone of management by doing pericardiectomy. Aim of the Study: This study aimed to review the surgical management of constrictive pericarditis and its surgical outcome. Materials and Methods: A retrospective study involved 13 patients with constrictive pericarditis in the Iraqi-cardiac surgery center in Iraqi-Cardiac Surgery Center in Baghdad Medical Complex and Ibn Al-Bitar center for cardiac surgery from 2011 to 2015. Eight (61.5%) of them were female, and the rest (38.5%) were male. Their ages ranged between 10 and 32 years old (the mean age was 21 years). The data were collected from the medical records of the patients. Results: The majority of patients were in the age group of 20–29 years (46.1%). The youngest was 10 years old. Dyspnea on exertion was the most presenting feature (61.5%). In the electrocardiogram, atrial fibrillation was found in three patients (23.2%), and a chest X-ray showed calcium deposition at the pericardium in eight patients (61.5%). Cardiac catheterization (right-sided) and transthoracic echo study also demonstrated the findings of the disease. None of the patients needed the by-pass machine. The biopsy results revealed that tuberculosis (TB) was the most frequent cause of pericarditis. Conclusion: Pericardiectomy is a useful surgical procedure to treat constructive pericarditis, and it was beneficial to all patients in this study, with improvement in their functional capacity. Another finding of significance is that despite intensive vaccination and the use of anti-TB drugs in our country, TB is still an important cause of constrictive pericarditis.