Waffle Procedure for Selected Patients with Constrictive Pericarditis

Pericardiectomy is the standard procedure used to relieve hemodynamic conditions produced by constrictive pericarditis (CP), a form of severe diastolic heart failure. CP is observed in 0.2%– 0.4% of patients undergoing cardiac surgery. They generally have experienced pericardial trauma or inflammation [1]. Despite its poor prognosis when untreated, CP is potentially curable. Surgical pericardiectomy can be performed at low operative risk. Cardiologists should have a high index of suspicion for CP in patients presenting with predominant right-sided heart failure (HF), particularly when accompanied by a history of cardiac surgery, pericarditis, and/or pericardial effusion. Transthoracic two-dimensional and Doppler echocardiography are usually the first diagnostic tools in the evaluation of HF and can reliably identify CP in most patients by the characteristic real-time motion of the heart and hemodynamic features. Computed tomography and magnetic resonance imaging provide incremental data for the diagnosis and management of CP and are especially helpful when clinical or echocardiographic findings are inconclusive. Cardiac catheterization has been the gold standard for the diagnosis of CP but may not be necessary if non-invasive tests demonstrate the diagnostic features of CP. Catheterization should then be reserved for selected cases or for assessing concomitant coronary disease. Although most patients with CP require pericardiectomy, antiinflammatory therapy may be curative in patients presenting with subacute symptoms, especially when evidence of marked ongoing inflammation is seen.