Pericardial Diseases

  • Rolando Calderon-Rojas
  • Hartzell V. SchaffEmail author


The pericardium is an important structure, and there are many diseases that affect it. The accurate and timely diagnosis of these diseases is essential to avoid the late sequelae of pericardial constriction and cardiac cirrhosis. Echocardiography remains the first choice investigation for the assessment of patients with suspected pericardial diseases. However, computed tomography and cardiac magnetic resonance imaging are often utilized in complex cases. Isolated pericardiectomy for constriction or for effusive/chronic relapsing pericarditis can be performed safely with low morbidity and mortality. This chapter focuses on etiology, pathophysiology, and diagnosis of common pericardial diseases and discusses in detail the role of pericardiectomy for the treatment of constrictive pericarditis.


Constrictive pericarditis Pericardium Pericarditis Pericardiectomy Pericardial effusion 


  1. 1.
    Hoit BD. Anatomy and physiology of the pericardium. Cardiol Clin. 2017;35:481–90.PubMedCrossRefGoogle Scholar
  2. 2.
    Johnston DR. Surgical management of pericardial diseases. Prog Cardiovasc Dis. 2017;59:407–16.PubMedCrossRefGoogle Scholar
  3. 3.
    Holt JP. The normal pericardium. Am J Cardiol. 1970;26:455–65.PubMedCrossRefGoogle Scholar
  4. 4.
    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;36:2921–64.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Imazio M, Trinchero R, Shabetai R. Pathogenesis, management, and prevention of recurrent pericarditis. J Cardiovasc Med. 2007;8:404–10.CrossRefGoogle Scholar
  6. 6.
    Khandaker MH, Espinosa RE, Nishimura RA, et al. Pericardial disease: diagnosis and management. Mayo Clin Proc. 2010;85:572–93.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Imazio M, Adler Y, Charron P. Recurrent pericarditis: modern approach in 2016. Curr Cardiol Rep. 2016;18:50.PubMedCrossRefGoogle Scholar
  8. 8.
    Soler-Soler J, Sagristà-Sauleda J, Permanyer-Miralda G. Relapsing pericarditis. Heart. 2004;90:1364–8.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Khandaker MH, Schaff HV, Greason KL, et al. Pericardiectomy vs medical management in patients with relapsing pericarditis. Mayo Clin Proc. 2012;87:1062–70.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Hoit BD. Pathophysiology of the pericardium. Prog Cardiovasc Dis. 2017;59:341–8.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Spodick DH. Acute cardiac tamponade. N Engl J Med. 2003;349:684–90.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Sternbach G. Claude Beck: cardiac compression triads. J Emerg Med. 1988;6:417–9.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Cho YH, Schaff HV. Surgery for pericardial disease. Heart Fail Rev. 2013;18:375–87.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Imazio M, Brucato A, Maestroni S, et al. Risk of constrictive pericarditis after acute pericarditis. Circulation. 2011;124:1270–5.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Tsang TSM, Barnes ME, Gersh BJ, Bailey KR, Seward JB. Outcomes of clinically significant idiopathic pericardial effusion requiring intervention. Am J Cardiol. 2003;91:704–7.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Lekhakul A, Assawakawintip C, Fenstad ER, et al. Safety and outcome of percutaneous drainage of pericardial effusions in patients with cancer. Am J Cardiol. 2018;122:1091. Scholar
  17. 17.
    Piehler JM, Pluth JR, Schaff HV, Danielson GK, Orszulak TA, Puga FJ. Surgical management of effusive pericardial disease. Influence of extent of pericardial resection on clinical course. J Thorac Cardiovasc Surg. 1985;90:506–16.PubMedCrossRefGoogle Scholar
  18. 18.
    Mayosi BM, Burgess LJ, Doubell AF. Tuberculous pericarditis. Circulation. 2005;112:3608–16.PubMedCrossRefGoogle Scholar
  19. 19.
    Murashita T, Schaff HV, Daly RC, et al. Experience with pericardiectomy for constrictive pericarditis over eight decades. Ann Thorac Surg. 2017;104:742–50.PubMedCrossRefGoogle Scholar
  20. 20.
    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;44:1023–8.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Syed FF, Schaff HV, Oh JK, et al. Nat Rev Cardiol. 2015;12:682.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Dines DE, Edwards JE, Burchell HB. Myocardial atrophy in constrictive pericarditis. Proc Staff Meet Mayo Clin. 1958;33:93–9.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Meyer TE, Sareli P, Marcus RH, Pocock W, Berk MR, McGregor M. Mechanism underlying Kussmaul’s sign in chronic constrictive pericarditis. Am J Cardiol. 1989;64:1069–72.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Bilchick KC, Wise RA. Paradoxical physical findings described by Kussmaul: pulsus paradoxus and Kussmaul’s sign. Lancet. 2002;359:1940–2.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Welch TD. Constrictive pericarditis: diagnosis, management and clinical outcomes. Heart. 2018;104:725–31.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Depboylu BC, Mootoosamy P, Vistarini N, Testuz A, El-Hamamsy I, Cikirikcioglu M. Surgical treatment of constrictive pericarditis. Tex Heart Inst J. 2017;44:101–6.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Miranda WR, Oh JK. Constrictive pericarditis: a practical clinical approach. Prog Cardiovasc Dis. 2017;59:369–79.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Gaudino M, Anselmi A, Pavone N, Massetti M. Constrictive pericarditis after cardiac surgery. Ann Thorac Surg. 2013;95:731–6.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Geske JB, Anavekar NS, Nishimura RA, Oh JK, Gersh BJ. Differentiation of constriction and restriction: complex cardiovascular hemodynamics. J Am Coll Cardiol. 2016;68:2329–47.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Hurrell DG, Nishimura RA, Higano ST, et al. Value of dynamic respiratory changes in left and right ventricular pressures for the diagnosis of constrictive pericarditis. Circulation. 1996;93:2007–13.PubMedCrossRefGoogle Scholar
  31. 31.
    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;51:315–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Talreja DR, Edwards WD, Danielson GK, et al. Constrictive pericarditis in 26 patients with histologically normal pericardial thickness. Circulation. 2003;108:1852–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Masui T, Finck S, Higgins CB. Constrictive pericarditis and restrictive cardiomyopathy: evaluation with MR imaging. Radiology. 1992;182:369–73.PubMedCrossRefGoogle Scholar
  34. 34.
    Angheloiu GO, Rayarao G, Williams R, Yamrozik J, Doyle M, Biederman RWW. Magnetic resonance characterization of septal bounce: findings of blood impact physiology. Int J Cardiovasc Imaging. 2015;31:105–13.PubMedCrossRefGoogle Scholar
  35. 35.
    Young PM, Glockner JF, Williamson EE, et al. MR imaging findings in 76 consecutive surgically proven cases of pericardial disease with CT and pathologic correlation. Int J Cardiovasc Imaging. 2012;28:1099–109.PubMedCrossRefGoogle Scholar
  36. 36.
    Anavekar NS, Wong BF, Foley TA, et al. Index of biventricular interdependence calculated using cardiac MRI: a proof of concept study in patients with and without constrictive pericarditis. Int J Cardiovasc Imaging. 2013;29:363–9.PubMedCrossRefGoogle Scholar
  37. 37.
    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;81:522–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Mizukami Y, Ueda N, Adachi H, Arikura J, Kondo K. Long-term outcomes after video-assisted thoracoscopic pericardiectomy for pericardial effusion. Ann Thorac Cardiovasc Surg. 2017;23:304–8.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Tokuda Y, Miyata H, Motomura N, et al. Outcome of pericardiectomy for constrictive pericarditis in Japan: a nationwide outcome study. Ann Thorac Surg. 2013;96:571–6.PubMedCrossRefGoogle Scholar
  40. 40.
    Shiraishi M, Yamaguchi A, Muramatsu K, et al. Validation of Waffle procedure for constrictive pericarditis with epicardial thickening. Gen Thorac Cardiovasc Surg. 2015;63:30–7.PubMedCrossRefGoogle Scholar
  41. 41.
    Lindblom D, Nyman J, Vedin J. Constrictive pericarditis with constrictive epicarditis. Asian Cardiovasc Thorac Ann. 2009;17:102–4.PubMedCrossRefGoogle Scholar
  42. 42.
    Nataf P, Cacoub P, Dorent R, et al. Results of subtotal pericardiectomy for constrictive pericarditis. Eur J Cardiothorac Surg. 1993;7:252–5.PubMedCrossRefGoogle Scholar
  43. 43.
    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;93:1236–40.PubMedCrossRefGoogle Scholar
  44. 44.
    Veeragandham RS, Goldin MD. Surgical management of radiation-induced heart disease. Ann Thorac Surg. 1998;65:1014–9.PubMedCrossRefGoogle Scholar
  45. 45.
    Brosius FC III, Waller BF, Roberts WC. Radiation heart disease. Analysis of 16 young (aged 15 to 33 years) necropsy patients who received over 3,500 rads to the heart. Am J Med. 1981;70:519–30.PubMedCrossRefGoogle Scholar
  46. 46.
    Madeira M, Teixeira R, Costa M, Gonçalves L, Klein AL. Two-dimensional speckle tracking cardiac mechanics and constrictive pericarditis: systematic review. Echocardiography. 2016;33:1589–99.PubMedCrossRefGoogle Scholar
  47. 47.
    Góngora E, Dearani JA, Orszulak TA, Schaff HV, Li Z, Sundt TM III. Tricuspid regurgitation in patients undergoing pericardiectomy for constrictive pericarditis. Ann Thorac Surg. 2008;85:163–70.PubMedCrossRefGoogle Scholar
  48. 48.
    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;48:e110–6.PubMedGoogle Scholar
  49. 49.
    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;65:662–70.PubMedCrossRefGoogle Scholar
  50. 50.
    Johnson TL, Bauman WB, Josephson RA. Worsening tricuspid regurgitation following pericardiectomy for constrictive pericarditis. Chest. 1993;104:79–81.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Calderon-Rojas R, Greason KL, Oh JK, et al. P4582Tricuspid valve regurgitation in patients with constrictive pericarditis. Eur Heart J. 2018;39(Suppl 1)
  52. 52.
    Doshi S, Ramakrishnan S, Gupta SK. Invasive hemodynamics of constrictive pericarditis. Indian Heart J. 2015;67:175–82.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Division of Cardiovascular SurgeryMayo ClinicRochesterUSA

Personalised recommendations