Perioperative and Surgical Management of Constrictive Pericarditis

Lamis El Harake; Mohamed Al-Kazaz; Paul C. Cremer; Douglas R. Johnston

doi:10.14797/mdcvj.1789

Perioperative and Surgical Management of Constrictive Pericarditis

Methodist DeBakey Cardiovascular Journal

Volume 22 (2026): Issue 2

By: Lamis El Harake , Mohamed Al-Kazaz , Paul C. Cremer and Douglas R. Johnston

Open Access

|Mar 2026

Miranda WR, Oh JK. Constrictive Pericarditis: A Practical Clinical Approach. Prog Cardiovasc Dis. 2017 Jan-Feb;59(4):369-379. doi: 10.1016/j.pcad.2016.12.008
Open DOI Search in Google Scholar Back to article
Al-Kazaz M, Klein AL, Oh JK, et al. Pericardial Diseases and Best Practices for Pericardiectomy: JACC State-of-the-Art Review. J Am Coll Cardiol. 2024 Aug 6;84(6):561-580. doi: 10.1016/j.jacc.2024.05.048
Open DOI Search in Google Scholar Back to article
Wang TKM, Klein AL, Cremer PC, et al. 2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on the Diagnosis and Management of Pericarditis: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2025 Dec 23;86(25):2691-2719. doi: 10.1016/j.jacc.2025.05.023
Open DOI Search in Google Scholar Back to article
Sagristà-Sauleda J, Angel J, Sánchez A, Permanyer-Miralda G, Soler-Soler J. Effusive-constrictive pericarditis. N Engl J Med. 2004 Jan 29;350(5):469-75. doi: 10.1056/NEJMoa035630
Open DOI Search in Google Scholar Back to article
Hancock EW. A clearer view of effusive-constrictive pericarditis. N Engl J Med. 2004 Jan 29;350(5):435-7. doi: 10.1056/NEJMp038199
Open DOI Search in Google Scholar Back to article
Lawrence JS, Morton JJ. Chronic Constrictive Pericarditis. Successful Partial Resection of the Pericardium in Two Patients. Trans Am Clin Climatol Assoc. 1938;54:87-95.
Search in Google Scholar Back to article
Unai S, Johnston DR. Radical Pericardiectomy for Pericardial Diseases. Curr Cardiol Rep. 2019 Feb 12;21(2):6. doi: 10.1007/s11886-019-1092-1
Open DOI Search in Google Scholar Back to article
Hoit BD. Pathophysiology of the Pericardium. Prog Cardiovasc Dis. 2017 Jan-Feb;59(4):341-348. doi: 10.1016/j.pcad.2016.11.001
Open DOI Search in Google Scholar Back to article
Johnston DR. Surgical Management of Pericardial Diseases. Prog Cardiovasc Dis. 2017 Jan-Feb;59(4):407-416. doi: 10.1016/j.pcad.2017.01.005
Open DOI Search in Google Scholar Back to article
Mori S, Bradfield JS, Peacock WJ, Anderson RH, Shivkumar K. Living Anatomy of the Pericardial Space: A Guide for Imaging and Interventions. JACC Clin Electrophysiol. 2021 Dec;7(12):1628-1644. doi: 10.1016/j.jacep.2021.09.008
Open DOI Search in Google Scholar Back to article
Chetrit M, Xu B, Kwon DH, et al. Imaging-Guided Therapies for Pericardial Diseases. JACC Cardiovasc Imaging. 2020 Jun;13(6):1422-1437. doi: 10.1016/j.jcmg.2019.08.027
Open DOI Search in Google Scholar Back to article
Rodriguez ER, Tan CD. Structure and Anatomy of the Human Pericardium. Prog Cardiovasc Dis. 2017 Jan-Feb;59(4):327-340. doi: 10.1016/j.pcad.2016.12.010
Open DOI Search in Google Scholar Back to article
Talreja DR, Edwards WD, Danielson GK, et al. Constrictive pericarditis in 26 patients with histologically normal pericardial thickness. Circulation. 2003 Oct 14;108(15):1852-7. doi: 10.1161/01.CIR.0000087606.18453.FD
Open DOI Search in Google Scholar Back to article
Hatle LK, Appleton CP, Popp RL. Differentiation of constrictive pericarditis and restrictive cardiomyopathy by Doppler echocardiography. Circulation. 1989 Feb;79(2):357-70. doi: 10.1161/01.cir.79.2.357
Open DOI Search in Google Scholar Back to article
Welch TD. Constrictive pericarditis: diagnosis, management and clinical outcomes. Heart. 2018 May;104(9):725-731. doi: 10.1136/heartjnl-2017-311683
Open DOI Search in Google Scholar Back to article
Bertog SC, Thambidorai SK, Parakh K, et al. Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy. J Am Coll Cardiol. 2004 Apr 21;43(8):1445-52. doi: 10.1016/j.jacc.2003.11.048
Open DOI Search in Google Scholar Back to article
Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015 Nov 7;36(42):2921-2964. doi: 10.1093/eurheartj/ehv318
Open DOI Search in Google Scholar Back to article
Miranda WR, Oh JK. Effusive-Constrictive Pericarditis. Cardiol Clin. 2017 Nov;35(4):551-558. doi: 10.1016/j.ccl.2017.07.008
Open DOI Search in Google Scholar Back to article
Imazio M, Brucato A, Rovere ME, et al. Contemporary features, risk factors, and prognosis of the post-pericardiotomy syndrome. Am J Cardiol. 2011 Oct 15;108(8):1183-7. doi: 10.1016/j.amjcard.2011.06.025
Open DOI Search in Google Scholar Back to article
Mayosi BM, Burgess LJ, Doubell AF. Tuberculous pericarditis. Circulation. 2005 Dec 6;112(23):3608-16. doi: 10.1161/CIRCULATIONAHA.105.543066
Open DOI Search in Google Scholar Back to article
Sagristà-Sauleda J, Permanyer-Miralda G, Soler-Soler J. Tuberculous pericarditis: ten year experience with a prospective protocol for diagnosis and treatment. J Am Coll Cardiol. 1988 Apr;11(4):724-728. doi: 10.1016/0735-1097(88)90203-3
Open DOI Search in Google Scholar Back to article
George TJ, Arnaoutakis GJ, Beaty CA, Kilic A, Baumgartner WA, Conte JV. Contemporary etiologies, risk factors, and outcomes after pericardiectomy. Ann Thorac Surg. 2012 Aug;94(2):445-451. doi: 10.1016/j.athoracsur.2012.03.079
Open DOI Search in Google Scholar Back to article
Klein AL, Wang TKM, Cremer PC, et al. Pericardial Diseases: International Position Statement on New Concepts and Advances in Multimodality Cardiac Imaging. JACC Cardiovasc Imaging. 2024 Aug;17(8):937-988. doi: 10.1016/j.jcmg.2024.04.010
Open DOI Search in Google Scholar Back to article
Welch TD, Ling LH, Espinosa RE, et al. Echocardiographic diagnosis of constrictive pericarditis: Mayo Clinic criteria. Circ Cardiovasc Imaging. 2014 May;7(3):526-34. doi: 10.1161/CIRCIMAGING.113.001613
Open DOI Search in Google Scholar Back to article
Ha JW, Oh JK, Ling LH, Nishimura RA, Seward JB, Tajik AJ. Annulus paradoxus: transmitral flow velocity to mitral annular velocity ratio is inversely proportional to pulmonary capillary wedge pressure in patients with constrictive pericarditis. Circulation. 2001 Aug 28;104(9):976-8. doi: 10.1161/hc3401.095705
Open DOI Search in Google Scholar Back to article
Sengupta PP, Huang YM, Bansal M, et al. Cognitive Machine-Learning Algorithm for Cardiac Imaging: A Pilot Study for Differentiating Constrictive Pericarditis From Restrictive Cardiomyopathy. Circ Cardiovasc Imaging. 2016 Jun;9(6):e004330. doi: 10.1161/CIRCIMAGING.115.004330
Open DOI Search in Google Scholar Back to article
Sengupta PP, Krishnamoorthy VK, Abhayaratna WP, et al. Disparate patterns of left ventricular mechanics differentiate constrictive pericarditis from restrictive cardiomyopathy. JACC Cardiovasc Imaging. 2008 Jan;1(1):29-38. doi: 10.1016/j.jcmg.2007.10.006
Open DOI Search in Google Scholar Back to article
Wang TKM, Ayoub C, Chetrit M, et al. Cardiac Magnetic Resonance Imaging Techniques and Applications for Pericardial Diseases. Circ Cardiovasc Imaging. 2022 Jul;15(7):e014283. doi: 10.1161/CIRCIMAGING.122.014283
Open DOI Search in Google Scholar Back to article
Cremer PC, Tariq MU, Karwa A, et al. Quantitative assessment of pericardial delayed hyperenhancement predicts clinical improvement in patients with constrictive pericarditis treated with anti-inflammatory therapy. Circ Cardiovasc Imaging. 2015 May;8(5):e003125. doi: 10.1161/CIRCIMAGING.114.003125
Open DOI Search in Google Scholar Back to article
Feng D, Glockner J, Kim K, et al. Cardiac magnetic resonance imaging pericardial late gadolinium enhancement and elevated inflammatory markers can predict the reversibility of constrictive pericarditis after antiinflammatory medical therapy: a pilot study. Circulation. 2011 Oct 25;124(17):1830-7. doi: 10.1161/CIRCULATIONAHA
Open DOI Search in Google Scholar Back to article
Doshi S, Ramakrishnan S, Gupta SK. Invasive hemodynamics of constrictive pericarditis. Indian Heart J. 2015 Mar-Apr;67(2):175-82. doi: 10.1016/j.ihj.2015.04.011
Open DOI Search in Google Scholar Back to article
Vaitkus PT, Kussmaul WG. Constrictive pericarditis versus restrictive cardiomyopathy: a reappraisal and update of diagnostic criteria. Am Heart J. 1991 Nov;122(5):1431-41. doi: 10.1016/0002-8703(91)90587-8
Open DOI Search in Google Scholar Back to article
Talreja DR, Nishimura RA, Oh JK, Holmes DR. Constrictive pericarditis in the modern era: novel criteria for diagnosis in the cardiac catheterization laboratory. J Am Coll Cardiol. 2008 Jan 22;51(3):315-9. doi: 10.1016/j.jacc.2007.09.039
Open DOI Search in Google Scholar Back to article
Nishimura RA. Constrictive pericarditis in the modern era: a diagnostic dilemma. Heart. 2001 Dec;86(6):619-23. doi: 10.1136/heart.86.6.619
Open DOI Search in Google Scholar Back to article
Calderon-Rojas R, Greason KL, King KS, et al. Tricuspid Valve Regurgitation in Patients Undergoing Pericardiectomy for Constrictive Pericarditis. Semin Thorac Cardiovasc Surg. 2020;32(4):721-728. doi: 10.1053/j.semtcvs.2020.03.003
Open DOI Search in Google Scholar Back to article
Choudhry MW, Homsi M, Mastouri R, Feigenbaum H, Sawada SG. Prevalence and Prognostic Value of Right Ventricular Systolic Dysfunction in Patients With Constrictive Pericarditis Who Underwent Pericardiectomy. Am J Cardiol. 2015 Aug 1;116(3):469-73. doi: 10.1016/j.amjcard.2015.04.044
Open DOI Search in Google Scholar Back to article
Schulz-Menger J, Collini V, Gröschel J, et al. 2025 ESC Guidelines for the management of myocarditis and pericarditis. Eur Heart J. 2025 Oct 22;46(40):3952-4041. doi: 10.1093/eurheartj/ehaf192
Open DOI Search in Google Scholar Back to article
Reuter H, Burgess LJ, Louw VJ, Doubell AF. The management of tuberculous pericardial effusion: experience in 233 consecutive patients. Cardiovasc J S Afr. 2007 Jan-Feb;18(1):20-5. PMID: 17392991
Search in Google Scholar Back to article
Geske JB, Anavekar NS, Nishimura RA, Oh JK, Gersh BJ. Differentiation of Constriction and Restriction: Complex Cardiovascular Hemodynamics. J Am Coll Cardiol. 2016 Nov 29;68(21):2329-2347. doi: 10.1016/j.jacc.2016.08.050
Open DOI Search in Google Scholar Back to article
Pahwa S, Crestanello J, Miranda W, et al. Outcomes of pericardiectomy for constrictive pericarditis following mediastinal irradiation. J Card Surg. 2021 Dec;36(12):4636-4642. doi: 10.1111/jocs.15996
Open DOI Search in Google Scholar Back to article
Diaz Soto JC, Mauermann WJ, Lahr BD, Schaff HV, Luis SA, Smith MM. MELD and MELD XI Scores as Predictors of Mortality After Pericardiectomy for Constrictive Pericarditis. Mayo Clin Proc. 2021 Mar;96(3):619-635. doi: 10.1016/j.mayocp.2020.08.048
Open DOI Search in Google Scholar Back to article
Komoda T, Frumkin A, Knosalla C, Hetzer R. Child-Pugh score predicts survival after radical pericardiectomy for constrictive pericarditis. Ann Thorac Surg. 2013 Nov;96(5):1679-85. doi: 10.1016/j.athoracsur.2013.06.016
Open DOI Search in Google Scholar Back to article
Tzani A, Doulamis IP, Tzoumas A, et al. Meta-Analysis of Population Characteristics and Outcomes of Patients Undergoing Pericardiectomy for Constrictive Pericarditis. Am J Cardiol. 2021 May 1;146:120-127. doi: 10.1016/j.amjcard.2021.01.033
Open DOI Search in Google Scholar Back to article
Busch C, Penov K, Amorim PA, et al. Risk factors for mortality after pericardiectomy for chronic constrictive pericarditis in a large single-centre cohort. Eur J Cardiothorac Surg. 2015 Dec;48(6):e110-6. doi: 10.1093/ejcts/ezv322
Open DOI Search in Google Scholar Back to article
Tabucanon RS, Wang TKM, Chetrit M, et al. Worsened Tricuspid Regurgitation Following Pericardiectomy for Constrictive Pericarditis. Circ Cardiovasc Imaging. 2021 Oct;14(10):e012948. doi: 10.1161/CIRCIMAGING.121.012948
Open DOI Search in Google Scholar Back to article
Syed FF, Ntsekhe M, Mayosi BM, Oh JK. Effusive-constrictive pericarditis. Heart Fail Rev. 2013 May;18(3):277-87. doi: 10.1007/s10741-012-9308-0
Open DOI Search in Google Scholar Back to article
Kim KH, Miranda WR, Sinak LJ, et al. Effusive-Constrictive Pericarditis After Pericardiocentesis: Incidence, Associated Findings, and Natural History. JACC Cardiovasc Imaging. 2018 Apr;11(4):534-541. doi: 10.1016/j.jcmg.2017.06.017
Open DOI Search in Google Scholar Back to article
Chowdhury UK, Subramaniam GK, Kumar AS, et al. Pericardiectomy for constrictive pericarditis: a clinical, echocardiographic, and hemodynamic evaluation of two surgical techniques. Ann Thorac Surg. 2006 Feb;81(2):522-9. doi: 10.1016/j.athoracsur.2005.08.009
Open DOI Search in Google Scholar Back to article
Cho IJ, Shim CY, Moon SH, et al. Deceleration time of left ventricular outflow tract flow as a simple surrogate marker for central haemodynamics at rest and as well as during exercise. Eur Heart J Cardiovasc Imaging. 2017 May 1;18(5):568-575. doi: 10.1093/ehjci/jew099
Open DOI Search in Google Scholar Back to article
Cho YH, Schaff HV, Dearani JA, et al. Completion pericardiectomy for recurrent constrictive pericarditis: importance of timing of recurrence on late clinical outcome of operation. Ann Thorac Surg. 2012 Apr;93(4):1236-40. doi: 10.1016/j.athoracsur.2012.01.049
Open DOI Search in Google Scholar Back to article
Khandaker MH, Schaff HV, Greason KL, et al. Pericardiectomy vs medical management in patients with relapsing pericarditis. Mayo Clin Proc. 2012 Nov;87(11):1062-70. doi: 10.1016/j.mayocp.2012.05.024
Open DOI Search in Google Scholar Back to article
Gillaspie EA, Stulak JM, Daly RC, et al. A 20-year experience with isolated pericardiectomy: Analysis of indications and outcomes. J Thorac Cardiovasc Surg. 2016 Aug;152(2):448-58. doi: 10.1016/j.jtcvs.2016.03.098
Open DOI Search in Google Scholar Back to article
Ntsekhe M, Shey Wiysonge C, Commerford PJ, Mayosi BM. The prevalence and outcome of effusive constrictive pericarditis: a systematic review of the literature. Cardiovasc J Afr. 2012 Jun;23(5):281-5. doi: 10.5830/CVJA-2011-072
Open DOI Search in Google Scholar Back to article
Moros D, Zaki A, Tong MZ. Surgical Approaches for Pericardial Diseases: What Is New? Curr Cardiol Rep. 2023 Dec;25(12):1705-1713. doi: 10.1007/s11886-023-01986-4
Open DOI Search in Google Scholar Back to article
Hemmati P, Greason KL, Schaff HV. Contemporary Techniques of Pericardiectomy for Pericardial Disease. Cardiol Clin. 2017 Nov;35(4):559-566. doi: 10.1016/j.ccl.2017.07.009
Open DOI Search in Google Scholar Back to article
Szabó G, Schmack B, Bulut C, et al. Constrictive pericarditis: risks, aetiologies and outcomes after total pericardiectomy: 24 years of experience. Eur J Cardiothorac Surg. 2013 Dec;44(6):1023-8; discussion 1028. doi: 10.1093/ejcts/ezt138
Open DOI Search in Google Scholar Back to article
Beckmann E, Ismail I, Cebotari S, et al. Right-Sided Heart Failure and Extracorporeal Life Support in Patients Undergoing Pericardiectomy for Constrictive Pericarditis: A Risk Factor Analysis for Adverse Outcome. Thorac Cardiovasc Surg. 2017 Dec;65(8):662-670. doi: 10.1055/s-0036-1593817
Open DOI Search in Google Scholar Back to article
Murashita T, Schaff HV, Daly RC, et al. Experience With Pericardiectomy for Constrictive Pericarditis Over Eight Decades. Ann Thorac Surg. 2017 Sep;104(3):742-750. doi: 10.1016/j.athoracsur.2017.05.063
Open DOI Search in Google Scholar Back to article

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DOI: https://doi.org/10.14797/mdcvj.1789 | Journal eISSN: 1947-6108

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Language: English

Page range: 97 - 109

Submitted on: Jan 26, 2026

Accepted on: Feb 4, 2026

Published on: Mar 10, 2026

Published by: Houston Methodist DeBakey Heart & Vascular Center

In partnership with: Paradigm Publishing Services

Keywords:

constrictive pericarditis,

effusive-constrictive pericarditis,

radical pericardiectomy,

surgical management,

multimodality imaging,

radiation-associated heart disease

© 2026 Lamis El Harake, Mohamed Al-Kazaz, Paul C. Cremer, Douglas R. Johnston, published by Houston Methodist DeBakey Heart & Vascular Center
This work is licensed under the Creative Commons Attribution-NonCommercial 4.0 License.

Volume 22 (2026): Issue 2