**4. Pathophysiology**

In case of constrictive pericarditis, restricted diastolic heart distensibility does exist and may provoke a right and a left ventricular preload decrease with a reduction of stroke volume and cardiac output [2, 3]. In Africa, we use to face on late clinical presentation of patients with massive pericardial thickness and calcifications inducting myocardial atrophy, fibrosis, and severe systolic dysfunction that significantly affect the results after pericardiectomy.

Key observations are described:


**43**

**6. Diagnosis**

*Chronic Constrictive Pericarditis (CCP) in Africa: Epidemiology, Etiology, Diagnosis…*

Classically, constrictive pericarditis appears as a complication of acute or effusive pericarditis. From Yadav's study [4], approximately 9% of patients with acute pericarditis will contract a pericardial constriction. In Africa, the frequency of acute pericarditis varies widely with geographical location ranging from 2 to 11.3% among patients admitted in a hospital for cardiovascular diseases [5–7]; it affects mostly young male population with an average age between 26 and 42 years old and tuberculosis as the most frequent etiology from 33 to 69.5% in sub-Saharan Africa [5, 6, 8]. Over the past decades, the incidence of tuberculous pericarditis has risen up because of the HIV epidemic in sub-Saharan Africa [8, 9]. Noubiap et al. [10] have reported a comprehensive understanding of the epidemiology of pericardial diseases in Africa confirming clearly that tuberculosis remains as the leading cause of pericardial diseases in African Resource-Limited Settings with poor outcome marked by a mortality rate between 18 and 25% including a very high one of 40% within 6 months among patients with HIV/AIDS positive. However, pericardial tuberculosis frequency is variable according to authors such as Mayosi [11] and Thwaites [12] who found, respectively, pericardial tuberculosis in 69.5% of cases admitted for pericardiocentesis and in 10% of all hospitalized patients with heart failure. Moreover, the risk for developing constrictive is very high for tuberculosis or purulent pericarditis: 20–30% and in almost all the cases of tuberculous pericarditis as reported by Gupta [13]. In their prospective study on 500 consecutive cases, Imazzio et al. [14] have demonstrated that the evolution from non-constrictive pericarditis to constriction is different according to pericarditis etiology: the risk of constriction is greater for bacterial etiologies (tuberculosis or purulent pericarditis) than viral or idiopathic acute pericarditis; the incidence rate of constriction is, respectively, 31.65 cases per 1000 person-years for tuberculous pericarditis and 52.74 person-years for purulent pericarditis versus 0.76 person-years for viral or idiopathic pericarditis. The same observation has been described by Permanyer-Miralda et al. [15] in a prospective study of patients with occurrence of constriction in 56 and 35% of patients with tuberculous and purulent pericarditis, respectively, and in 17% of patients with neoplastic pericarditis after an acute pericarditis. In Africa, and in literature overall, the epidemiological pattern, incidence, and prevalence of CCP are not well elucidated. Nevertheless, it is known that tuberculosis is the most frequent etiology of constrictive pericarditis in Africa and emerging countries (40–90%) [16] versus other rare etiology in our practice such as constrictive pericarditis after surgery. In a recent study, Gaudino et al. [17] have concluded their study insisting on the fact that constrictive pericarditis after surgery has its own pathophysiological characteristics, but we still be ignorant on its real origin and pathogenesis. Therefore, we should be vigilant and keep in mind that any cardiac symptoms without explanation must be suspected and be treated surgically as soon as

*DOI: http://dx.doi.org/10.5772/intechopen.84887*

possible if there is any doubt of pericardial constriction.

In African countries [18–26], the diagnosis of constrictive pericarditis is usually obvious for patients present late after the development of the constrictive process characterized mostly by advanced clinical manifestations of right-sided heart failure (50–100%), progressive New York Heart Association (NYHA) Functional Class III or IV (42–100%) associated with an evident antecedent pulmonary and extra-pulmonary tuberculosis such as tuberculous pericarditis (26–99%). Duration of illness prior to surgery may range from 1 month to 25 years with an average of 15 or 30 months found, respectively, by Ali et al. [26] and Yangni-Angate et al. [21].

**5. Epidemiology and etiology**

All those consequences determine the so called "Dip-and-plateau waveform."

*Chronic Constrictive Pericarditis (CCP) in Africa: Epidemiology, Etiology, Diagnosis… DOI: http://dx.doi.org/10.5772/intechopen.84887*
