Division of Cardiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
Heart Fail Rev. 2013 May;18(3):277-87. doi: 10.1007/s10741-012-9308-0.
Effusive-constrictive pericarditis (ECP) is an increasingly recognized clinical syndrome. It has been best characterized in patients with tamponade who continue to have elevated intracardiac pressure after the removal of pericardial fluid. The disorder is due to pericardial inflammation causing constriction in conjunction with the presence of pericardial fluid under pressure. The etiology is diverse with similar causes to constrictive pericarditis and the condition is more prevalent with certain etiologies such as tuberculous pericarditis. The diagnosis is most accurately made using simultaneous intrapericardial and right atrial pressure measurements with pericardiocentesis, although non-invasive Doppler hemodynamic assessment can assess residual hemodynamic findings of constriction following pericardiocentesis. The clinical presentation has considerable overlap with other pericardial syndromes and as yet there are no biomarkers or non-invasive findings that can accurately predict the condition. Identifying patients with ECP therefore requires a certain index of clinical suspicion at the outset, and in practice, a proportion of patients may be identified once there is objective evidence for persistent atrial pressure elevation after pericardiocentesis. Although a significant number of patients will require pericardiectomy, a proportion of patients have a predominantly inflammatory and reversible pericardial reaction and may improve with the treatment of the underlying cause and the use of anti-inflammatory medications. Patients should therefore be observed for the improvement on these treatments for a period, whenever possible, before advocating pericardiectomy. Imaging modalities identifying ongoing pericardial inflammation such as contrast-enhanced magnetic resonance imaging or nuclear imaging may identify those subsets more likely to respond to medical therapies. Pericardiectomy, if necessary, requires removal of the visceral pericardium.
渗出性缩窄性心包炎（ECP）是一种越来越被认识到的临床综合征。它在那些心包积液清除后继续存在升高的心内压的填塞患者中得到了最好的描述。这种疾病是由于心包炎症引起的缩窄，同时存在受压的心包积液。病因多种多样，与缩窄性心包炎的病因相似，某些病因如结核性心包炎更为常见。诊断最准确的方法是在心包穿刺时同时测量心包内和右心房压力，尽管非侵入性多普勒血流动力学评估可以评估心包穿刺后缩窄的残余血流动力学发现。临床表现与其他心包综合征有很大的重叠，目前还没有生物标志物或非侵入性发现可以准确预测这种情况。因此，识别 ECP 患者需要在一开始就有一定的临床怀疑指数，实际上，一旦心包穿刺后存在持续的心房压力升高的客观证据，就可能会发现一部分患者。尽管相当多的患者需要心包切除术，但一部分患者存在主要的炎症和可逆转的心包反应，可能会随着潜在病因的治疗和抗炎药物的使用而改善。因此，只要有可能，患者应在这些治疗方法取得改善后观察一段时间，然后再主张心包切除术。识别持续心包炎症的影像学方式，如增强磁共振成像或核成像，可能会识别出那些更可能对药物治疗有反应的亚组。如果需要心包切除术，则需要切除内脏心包。
