Clinical features, management and outcome of patients with constrictive pericarditis – Experience from a third world country

Objectives: To study the clinical features, management and outcome of patients with constrictive pericarditis, at a tertiary care hospital of Pakistan. Design: Descriptive study. Material & method: All consecutive patients with the final diagnosis of constrictive pericarditis, admitted at Aga Khan University Hospital Karachi, during the year 2005 to 2015 were included in the study. Results: A total of 21 patients were diagnosed and managed as constrictive pericarditis during the above mentioned period. Mean age was 39 + 19.9 years. There was a male preponderance with a male to female ratio of 2.5:1.The most common clinical features were those of right heart failure. Only 2 (9.5%) patients showed pericardial calcification on X-ray chest. Dilated atria and septal bounce were the most common echo features present in 15 (71.4%). MRI/CT was done in only 11 patients, of which eight showed increased pericardial thickness. Three had normal pericardial thickness on MRI/CT but were proved to have constriction surgically. Cardiac catheterization was done in nine patients only. Elevated filling pressures and square root sign were the most common findings, present in all (100%). Pericardiectomy was performed in 12 (57%) patients. Five more patients were advised surgery but two died before the surgery and three were taken to other hospitals as they wanted to explore other options beside surgery. Pericardial tissue histopathology was available in only 11 patients. It revealed tuberculosis in three cases, while in 8 cases it was nonspecific. Six patients died with an overall mortality of 28.6%. Five patients died during hospitalization, four without surgery and one after the surgery. One patient died during follow up (was considered unfit for the surgery). Mean follow up duration was 7.3 + 9.3 months. No death occurred on follow up in surgically treated patients. Conclusion: Features of right heart failure is the most common mode of presentation of CP. The most probable etiology in this part of the world is tuberculosis, although difficult to prove on histopathology. Pericardiectomy is the usual recommended treatment due to advanced disease at the time of presentation