Constrictive pericarditis in the twenty-first century: An old disease revisited

Figure 1 Directed acyclic graph approach to pathophysiology of constrictive pericarditis. CP: Constrictive pericarditis; TB: Tuberculosis.

Figure 2 Chest X-ray. A: Postero-anterior; B: Left lateral. Postero-anterior and left lateral views showing curvilinear calcification around the heart.

Figure 3 Electrocardiography. Inverted T waves in precordial and limb leads, and low QRS voltage in limb leads.

Figure 4 Transthoracic echocardiography. A: Thickened and calcified pericardium in left parasternal short-axis view; B and C: Respirophasic shift of interventricular septum in apical 4-chamber view; D: Mitral valve E/A 2.2 in pulsed wave Doppler echocardiography; E: Medial mitral annular velocity 10.4 cm/second in tissue Doppler imaging; F: Dilated, non-collapsing inferior vena cava in two-dimensional-guided M-mode echocardiography in subcostal view.

Figure 5 Cardiac computed tomography scan. A and B: Thickened and calcified pericardium around the heart.

Figure 6 Diagnostic approach for constrictive pericarditis and effusive-constrictive pericarditis. CP: Constrictive pericarditis; ECP: Effusive-constrictive pericarditis; SOB: Shortness of breath; JVP: Jugular venous pressure; TTE: Transthoracic echocardiography; IVC: Inferior vena cava; MV: Mitral valve; ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein; CMR: Cardiac magnetic resonance.

Figure 7 Intraoperative findings. A: Heart is encircled with calcified pericardium; B: Egg shell-like calcification.

Figure 8 Treatment approach for constrictive pericarditis. CP: Constrictive pericarditis; ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein; CMR: Cardiac magnetic resonance; TB: Tuberculosis.

Figure 9 Cardiac computed tomography scan. A-C: Thickened and calcified visceral and parietal layers and pericardial effusion in the pericardial sac.