Constrictive pericarditis after cardiac surgery: report of three cases and review of the literature.

Constrictive pericarditis after cardiac surgery is a rare phenomenon occurring with an incidence of 0.2% to 0.3%. To date only 158 cases have been reported in the world literature. Symptoms include dyspnea (81%), chest pain (34%), and fatigue (29%). Peripheral edema (90%) and an elevated jugular venous pressure (86%) were the most common abnormal signs found during physical examination. Chest x-ray and ECG abnormalities were not helpful in making the diagnosis, and abnormal echocardiographic findings were reported in less than half of the cases. Computerized tomography and magnetic resonance imaging scans of the heart were usually of great diagnostic benefit. Diastolic equalization of cardiac pressures remains the sine que non for diagnosis. Oral steroids have been reported to favorably alter the course early in the disease, but pericardial stripping remains the definitive form of therapy. Operative mortality rates vary from 5.5% to 14.5%.