Surgical pericardiectomy is the definitive treatment for noninflammatory constrictive pericarditis and for inflammatory constrictive pericarditis that does not respond adequately to anti-inflammatory therapy. When active pericardial inflammation is present, anti-inflammatory therapy should generally be attempted before surgery, because transient constrictive physiology may improve and inflammation reduction may facilitate subsequent surgery if pericardiectomy remains necessary.

• Radical surgical pericardiectomy is recommended for noninflammatory constrictive pericarditis and for inflammatory constrictive pericarditis that fails anti-inflammatory therapy.
• Surgical radical pericardiectomy should remove the entire pericardium, including the anterior, diaphragmatic, and posterior pericardial segments, and is generally performed on cardiopulmonary bypass.
• Pericardiectomy should be performed at experienced tertiary surgical centers to optimize clinical outcomes.
• Partial anterior and/or diaphragmatic pericardiectomy is not recommended for constrictive pericarditis.
• In patients with transient or inflammatory constrictive pericarditis, anti-inflammatory therapy may resolve constrictive pathophysiology or reduce inflammation before surgery if pericardiectomy remains indicated.^[1]

• Transthoracic echocardiography is recommended for noninvasive hemodynamic assessment of constrictive pericarditis.
• Cardiac magnetic resonance imaging is recommended to identify pericardial inflammation as a potentially reversible cause of constrictive physiology.
• Cardiac computed tomography may be useful to identify pericardial calcification and to define thoracic anatomy before pericardiectomy.
• Invasive cardiac catheterization is recommended when noninvasive diagnostic methods are nondiagnostic or equivocal.^[1]