Constrictive pericarditis

Fibrinocalcic transformation of the pericardium in a rigid fibrous shell that constitues an obstacle to ventricular filling and leads to diastolic deficiency with a retained ejection fraction, and a clinical picture of right heart failure. In addition, the influence of breathing on the heart filling disappears (see pericardial effusion). A pulsus paradoxus is rarely present.

Clinical signs: dyspnea on exertion, tachycardia, hepatomegaly, ascitis, distended jugular veins (the CVP does not decrease or even increases during inspiration: Kussmaul's sign).

ECG: microvoltage.

Chest X-ray: pericardiac calcifications (25 %).

Echocardiography: thick pericardium (4 mm), brisk posterior displacement of the intraventricular septum to the LV at the beginning of diastole.

Possible causes of constrictive pericarditis:

- purulent or tubercular pericarditis (3-6 %)

- benign acute pericarditis (42-49 %)

- post-cardiotomy pericarditis (11-37 %)

- radiation pericarditis (9-31 %)

- collagenosis (3-7 %)

- Gaucher disease

- Mulibrey syndrome

Treatment: surgical pericardectomy.

Anesthetic implications:

keep spontaneous ventilation for ianesthesia induction, with ketamine or etomidate; risk of bleeding. Diastolic dysfunction may persist for several weeks after surgery.

References :

- Rawlinson E, Bagshaw O.
Anesthesia for children with pericardial effusion: a case series.
Pediatr Anesth 2012; 22: 1124-31.

- Grocott HP, Gulati H, Srinathan S, Mackensen GB.
Anesthesia and the patient with pericardial disease.
Can J Anesth 2011; 58: 952-66.

- Seidler S, Lebowitz D, Müller H.
Péricardite constrictive chronique.
Revue Médicale Suisse 2015 ; 11 :1166-71

Updated: December 2019