*10.2.1 Transient constrictive pericarditis*

In some cases of Constrictive Pericarditis, it resolves spontaneously or with antiinflammatory therapy. In a study conducted at the Mayo Clinic, 17% of Constrictive Pericarditis cases healed spontaneously without the need for surgery [65]. 67% of these cases were temporary Constrictive Pericarditis with effusion. Transient Constrictive Pericarditis most commonly occurs after cardiac surgery. It is also accepted that it may be idiopathic or have infection, trauma or malignancy. Most

#### **Figure 4.**

*Simplified diagnostic algorithm for the diagnosis and treatment of symptomatic constrictive pericarditis.*


#### **Table 4.**

*Catheterization findings in constrictive pericarditis and restrictive cardiomyopathy.*

patients who respond to steroid or non-steroidal anti-inflammatory drug therapy are most likely seen in pericarditis with high serum inflammatory marker levels and high DGE in cardiac MRI [61, 66]. In patients with subacute and distinct pericardial inflamation is reasonable to try 2–3 months of anti-inflammatory therapy [67]. The typical regimen of medical treatment consists of a non-steroidal anti-inflammatory drug with Colchicine or an oral steroid. However, more work needs to be done.

*2) Chronic Constrictive Pericarditis:* In most of the cases, constrictive pericarditis is chronic and progressive. Diuretic therapy is strictly palliative. The defined and accepted treatment is surgical total pericardiectomy (Pericardial decortication) [67]. Pericardiectomy is an elective surgery. Left anterior thoracotomy is performed by bilateral thoracotomy or median sternotomy. Decortication should be performed on the left and right ventricles, covering the anterolateral and diaphragmatic surfaces, from the phrenic nerve to the other phrenic nerve (if necessary, extending to the posterior of the left phrenic nerve). In this procedure, as much pericardium as possible should be removed (removal) to cover the diaphragmatic and posterolateral pericardium [68]. Pericardial stripping is started from the anterior aspect of the left ventricle and is performed towards the apex. The pericardium over the right ventricle and right atrium is then resected. If the pericardium on the right atrium and right ventricle is liberated first, pulmonary edema will develop as right ventricular output increases and left ventricular pressure continues. Although there are those who suggest that stripping the pericardium on the vena cava and right atrium is unnecessary, the majority recommends that pericardiectomy be performed in these regions as well. Most of the arrhythmias that occur during surgery are due to small infarcts in the coronary vessels. These arrhythmias are controlled with 0.1% lidocaine HCL. Although peeling of the pericardium over the atrium and vena cava is hemodynamically beneficial, the risk is high. To reduce the risk. A cardiopulmonary bypass can be used [69]. Careful care is required in the early postoperative period. Arterial and central venous pressure are monitored. Myocardial insufficiency due to chronic construction does not return to normal immediately after the operation. Low dopamine infusion is started for those with ventricular irritability. Existing hepatomegaly, ascites, edema continue for a few more months. Appropriate diuretics and protein loss are replaced.

### **11. Prognosis after pericardiectomy**

Depending on the prognosis etiology, it is seen that the patient's condition worsens after pericardiectomy in advanced stages of NYHA functional classification, elderly patient, impaired renal function, pulmonary hypertension, decreased Ejection fraction, increased Child Pugh liver disease [35, 37, 70]. Care should be taken not to injure the phrenic nerves during the pericardiectomy procedure. The mortality rate after pericardiectomy is 5–15%, and the most common cause is low cardiac output. The main cause of postoperative low cardiac output is myocardial atrophy caused by chronic constriction; myocardial fibrosis found in cases secondary to mediastinal radiation. After incomplete pericardiectomy, recurrent constrictive pericarditis is associated with an increased risk and reduced survival rate [71]. In the publications of several large volume centers, the mortality rate for surgical pericardiectomy has been reported as 6%–7.1% [34–37]. Long-term survival after pericardiectomy varies greatly depending on etiology and patient character, not age and gender [37]. For example; The cure rate of patients with idiopathic constrictive pericarditis is ≥80% in 5–7 years [34–36]. The long-term recovery rate after surgery is >80% in asymptomatic or mildly symptomatic patients [37]. On the other hand, it has been reported that the outcome after pericardiectomy is very poor in patients with constrictive pericarditis due to chest radiotherapy. The recovery rate in these is 0% - 30% for 5–10 years [34–37].
