What's New in Constrictive Pericarditis? A European Perspective.

Constrictive pericarditis (CP) is probably one of the major concerns of clinicians dealing with pericardial diseases in the longterm, as well as our patients. Constrictive pericarditis is the final result of different types of acute pericarditis. Recent data have clearly shown that the etiology of the initial acute pericarditis is the major risk factor for the evolution to a constrictive phase, since bacterial etiologies (purulent and tuberculous pericarditis) have a higher risk of this outcome (20% to 30%) compared with neoplastic etiologies or immune-mediated forms, as well as viral and idiopathic etiologies. Moreover, the risk is not related to the number of recurrences, but essentially to the etiology in both acute and recurrent pericarditis. Previous studies from the United States have suggested a possible increase of specific etiologies of CP, especially postcardiac surgery and post-radiation cases. However, data from developing countries with a high prevalence of tuberculosis, such as sub-Saharan Africa, suggest that this may be the predominant cause and thus, the etiological spectrum of CP is mainly affected by the presence of tuberculosis (Table) in a geographical area. On this basis, tuberculosis may become an emerging issue and cause of pericardial diseases associated with new immigration streams toward European countries. In the retrospective study published by Porta-Sánchez et al in Revista Española de Cardiologı́a, Spanish pericardial investigators review their experience of 140 consecutive cases of CP who underwent pericardiectomy between 1978 and 2012 in a tertiary referral center for pericardial diseases (Hospital Universitari Vall d’Hebron, Barcelona, Spain). These authors should be congratulated for their continuous efforts to improve our knowledge of pericardial diseases in the last 30 years and more. In the study, most patients had an idiopathic etiology (54%). All included patients underwent pericardiectomy with a perioperative mortality of 11%, which is consistent with previous surgical series. Different etiologies had similar mortality, although the