Surgical Treatment of Chronic Constrictive Pericarditis, Is Tuberculosis Still a Common Cause?

Background: Constrictive pericarditis (C.P) demonstrates a heterogeneous pattern and has different aetiologies depending on the geographic areas of reported pericarditis. Today in the western hemisphere radiation and previous cardiac surgery have become important causes of CP, but it seems that Tuberculosis is still a common cause of C.P in developing countries.Method Material: We reviewed the records of 45 patients with mean age of 46.6 years (21-84 yr.) and the diagnosis of CP who underwent pericardiectomy between1994-2006. Preoperatively 4.5% were in New York Heart Association (NYHA) Class I, 45.5% in class II, 47.7% in class III 2.3% in class IV. Pericardial calcification was seen in 21% of plain chest X-rays. The mean follow up period was 40+/-18 months (3-144 month).Results: Postoperatively, only 15.6% of patients were in NYHA class III and the rest were in class I (18.2%) or II (66.2%) , (P .001).The etiologic factors were Tuberculosis in 22.2%, chronic renal failure in 8.8%, post-sternotomy in 4.5% and malignancies in 4.5%. The cause of C.P was idiopathic in 60%. Low output state was the most common postoperative problem (22.3%). The overall mortality was 4.4%. There was one in-hospital death due to respiratory insufficiency in a tuberculosis patient and one patient died due to metastatic adenocarcinoma during follow up period.Conclusion: We conclude that tuberculosis, despite vaccination programs and anti-tubercular medications is still an important cause of chronic CP at least in our area. Pericardiectomy is an effective treatment of chronic CP because it provides an important and durable improvement in symptoms and functional status with low mortality.