This protocol applies to patients with constrictive pericarditis in whom active pericarditis is also present — confirmed by clinical criteria, biomarkers, and/or imaging evidence of ongoing pericardial inflammation. Empirical anti-inflammatory therapy is warranted only for those with such evidence of concomitant pericarditis.
First-line management in this setting is empiric anti-inflammatory therapy, sustained for at least 3–6 months. This protocol is indicated when that course has not achieved clinical remission with normalization of imaging findings and resolution of pericardial constriction.
DOI: 10.1093/eurheartj/ehaf192
Empirical anti-inflammatory therapy is warranted only for those with evidence of pericarditis (by clinical criteria, biomarkers, and/or imaging).
Pericardiectomy is the mainstay treatment for chronic constriction or CP not responding to anti-inflammatory therapy.
Complete pericardiectomy is recommended for the management of CP, as it offers superior long-term outcomes and significantly reduces the risk of recurrences compared with partial anterior or anterophrenic pericardiectomy, which may leave residual constrictive tissue and contribute to persistent or recurrent symptoms.
Surgical pericardiectomy is recommended in patients with chronic pericardial constriction or persistent constrictive pericarditis despite medical therapy to improve symptoms and survival.
Tricuspid valve repair is recommended in patients with pericardial constriction and severe tricuspid valve regurgitation to improve symptoms and survival.
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