CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 4, May 2012
206
AFRICA
Presentation pattern and management of effusive–
constrictive pericarditis in Ibadan
MA SALAMI, PO ADEOYE, VO ADEGBOYE, OA ADEBO
Abstract
Background:
Effusive–constrictive pericarditis is a syndrome
in which constriction by the visceral pericardium occurs in
the presence of a dense effusion in a free pericardial space.
Treatment of this disease is problematic because pericardio-
centesis does not relieve the impaired filling of the heart and
surgical removal of the visceral pericardium is challenging.
We sought to provide further information by addressing
the evolution and clinico-pathological pattern, and optimal
surgical management of this disease.
Methods:
We conducted a prospective review of a consecutive
series of five patients managed in the cardiothoracic surgery
unit of University College Hospital, Ibadan, in the previous
year, along with a general overview of other cases managed
over a seven-year period. This was followed by an extensive
literature review with a special focus on Africa.
Results:
The diagnosis of effusive–constrictive pericarditis
was established on the basis of clinical findings of features of
pericardial disease with evidence of pericardial effusion, and
echocardiographic finding of constrictive physiology with or
without radiological evidence of pericardial calcification. A
review of our surgical records over the previous seven years
revealed a prevalence of 13% among patients with pericar-
dial disease of any type (11/86), 22% of patients presenting
with effusive pericardial disease (11/50) and 35% who had
had pericardiectomy for constrictive pericarditis (11/31). All
five cases in this series were confirmed by a clinical scenario
of non-resolving cardiac impairment despite adequate open
pericardial drainage. They all improved following pericar-
diectomy.
Conclusion:
Effusive–constrictive pericarditis as a subset of
pericardial disease deserves closer study and individualisa-
tion of treatment. Evaluating patients suspected of having
the disease affords clinicians the opportunity to integrate
clinical features and non-invasive investigations with or
without findings at pericardiostomy, to derive a management
plan tailored to each patient. The limited number of patients
in this series called for caution in generalisation. Hence our
aim was to increase the sensitivity of others to issues raised
and help spur on further collaborative studies to lay down
guidelines with an African perspective.
Keywords:
pericarditis, effusive, constrictive, Ibadan, African
Submitted 24/5/10, accepted 5/10/11
Cardiovasc J Afr
2012;
23
: 206–211
DOI: 10.5830/CVJA-2011-066
Effusive–constrictive pericarditis is a clinical syndrome
characterised by concurrent pericardial effusion and pericardial
constriction where constrictive haemodynamics are persistent
after the pericardial effusion is removed. The treatment of
effusive–constrictive pericarditis is problematic because
pericardiocentesis does not relieve the impaired filling of the
heart, and surgical removal of the fibrinous exudate coating
the visceral pericardium may not be possible.
1
Pericardiectomy
following development of a pericardial skin that is amenable to
surgical stripping is usually the most successful treatment option.
The objectives of this case series were to document the evolution
and clinico-pathological pattern of this disease in Nigerians.
Methods
We conducted a prospective review of a consecutive series
of five patients managed in the cardiothoracic surgery unit
of University College Hospital, Ibadan in the previous year,
along with a general overview of other cases managed over a
seven-year period. This was followed by an extensive literature
review with a special focus on Africa. The diagnosis of
effusive–constrictive pericarditis was established on the basis
of clinical findings of features of pericardial disease with
evidence of pericardial effusion, and echocardiographic finding
of constrictive physiology with or without radiological evidence
of pericardial calcification.
Results
A review of our surgical records over the previous seven
years revealed a prevalence of 13% among patients with
pericardial disease of any type (11/86), 22% of patients
presenting with effusive pericardial disease (11/50) and 35%
who had pericardiectomy for constrictive pericarditis (11/31).
The present subset was chosen for the prospective follow up due
to the unusual consecutive presentation and a dearth of studies
specifically on this subset of patients from Africa.
All five cases in this series were confirmed by a clinical
scenario of non-resolving cardiac impairment despite adequate
open pericardial drainage. All five patients were prospectively
followed up. One patient, who we treated for effusive–contrictive
pericarditis, is described in detail and four other cases are
summarised in tabular form (Table 1).
Case studies
A 20-year-old, HIV sero-negative lady presented to the
Department of Surgery, Cardiovascular and Thoracic
Surgery Division, University College Hospital and College of
Medicine, University of Ibadan, Ibadan, Nigeria
MA SALAMI, MBBS, MRCS (Glasgow), FWACS, drmudathirsalami
@yahoo.com
PO ADEOYE, MBBS, FWACS
VO ADEGBOYE, MBBS, FMCS
College of Health Sciences, Bowen University, Iwo, Nigeria
OA ADEBO, FRCSC
