Which of the following statements about constrictive pericarditis is/are correct?

B. Results of pericardiectomy for constrictive pericarditis are worse in patients who develop constriction after mediastinal irradiation

D. If surgical treatment is planned for constrictive pericarditis it should involve total or complete pericardiectomy.

 DISCUSSION: The time course in the development of constrictive pericarditis after cardiac surgery ranges from 1 month to nearly 9 years, but the mean interval from surgery to presentation is about 23 months. Most series have reported poorer outcomes from pericardiectomy for postirradiation constrictive pericarditis, possibly owing to underlying myocardial fibrosis. In this subset, 5-year survival averages 50%, as compared with 75% for constrictive pericarditis of all causes. Constrictive pericarditis is a rare complication of acute pericarditis. As a result, drainage of asymptomatic (nonpurulent) pericardial effusions from acute pericarditis is not required. Patients with significant symptoms from constrictive pericarditis should undergo total pericardiectomy, even though this procedure carries an operative mortality rate of approximately 10%. Limited pericardiectomy has proven to be ineffective for this condition. It can be difficult to distinguish constrictive pericarditis from restrictive cardiomyopathy. Echocardiography may help by demonstrating chamber dimensions and wall motion abnormalities, but CT and MRI more accurately assess pericardial thickness.