CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 4, May 2012
AFRICA
211
Management
One can propose a management algorithm from the above
discussion (Fig. 5).We would suggest pericardiocentesis followed
by pericardiostomy and pericardial biopsy for bacteriology and
histology as a first step in patients with tamponade or imminent
tamponade. Duration of illness should be the next guide in
those without tamponade, with those patients with duration
more than one year offered pericardiostomy and biopsy. Other
patients could be tried on medical treatment for six to eight
weeks and operated on when there is persistent evidence of
constriction. Presence of pericardial thickening with calcification
following pericardiocentesis is an absolute indicator of need for
a pericardiectomy. This can be further confirmed on a cardiac
CT scan.
We believe this management algorithm is preliminary at best
and is subject to improvement with more collaborative research.
The current on-going multicentre study on the role of steroids in
the prevention of constrictive pericarditis, involving centres in
South Africa, Nigeria and other African countries, is one such
study.
4
Other studies could focus on influence of aetiology and
duration of pericardial disease on the need for pericardiectomy
in other areas.
Conclusion
Effusive–constrictive pericarditis as a subset of pericardial
disease deserves closer study and individualisation 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 expeditiously arrive at a patient-specific
management plan. The limited number of patients in this series is
a limitation, which calls 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.
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