This protocol applies to patients with pericardial constriction in the absence of active pericarditis — including those with established chronic constriction and those whose condition has not responded to medical therapy. These patients represent a distinct clinical group that requires prompt and definitive management.
In this setting, surgical intervention targeting the pericardium is the established primary approach. When significant valvular pathology is also present, concomitant valve surgery may be indicated.
Cases after failure of medical therapy and pericardial constriction without pericarditis should be referred for pericardiectomy without delay.
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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