Surgical Management Of Constrictive Pericarditis:

Ali Abd El-samia Shalaby

constrictive pericarditis is the end stage of chronic inflammatory process producing a fibrous thickenedconstricting pericardium surrounding the heart and so thediastolic ventricular filling has impaired, the systolicejection is limitted, too This process may be symmetricalcausing uniform restriction of all cardiac chambers or mayobe a localized bands constricting atrioventricular groove,one ventricle or both. In recent years, the spectrum ofAetilolgy of constrictive pericarditis showing importantchanges as tuberculous pericarditis has declined much moreespecially from western countries and not present now dayexcept in endemic areas. Anew cause has been introducedas the most important one which is an. idiopathicinflammations, also, post radiation therapy in the courseof some tumours management.After, 1.980s a new andinteresting factor is picKed up as during open heartsurgery, some antiseptic as povidine-iodine (Betadine) hasused for irrigation of pericarduim and that produceconstriction, also many other factors, as chronic renalfailure, collagen diseases and some malignant tumourscausing constriction of pericardium during its course ofillness. The difficulty of diagnoses of constrictivepericardi~is is due to similarity ofpathologicalits clinicalpresentation with manyhepatomegaly, congestiveconditions asheart •failure, and somemalignancy but new investigatory methods play an importantrole in the detection and diagnosis of the disease.Some·triales with medical treatment have been offeredbut the only effective way for management is the surgicalone, pericardiectomy through different approaches and bydifferent techniques leading to good haemodynamicimprovement and symptomatic relief