Este protocolo aplica-se a pacientes com constrição pericárdica na ausência de pericardite ativa — incluindo aqueles com constrição crônica estabelecida e aqueles cuja condição não respondeu ao tratamento clínico. Esses pacientes representam um grupo clínico distinto que requer manejo imediato e definitivo.
Neste contexto, a intervenção cirúrgica direcionada ao pericárdio é a abordagem primária estabelecida. Quando há patologia valvar significativa associada, a cirurgia valvar concomitante pode ser indicada.
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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