Background
Constrictive pericarditis is the end stage of a chronic inflammatory and non-inflammatory process that results in a thick,fibrotic,constricting,and sometimes calcific, pericardium.Early pericardiectomy has been advocated once the diagnosis has been confirmed. We report in this video presentation,a didactic case elaborating surgical techniques, with pre-and post-operative imaging.

Materials and Methods
A 63-year old male was hospitalised for severe anasarcic oedema of 2 weeks duration.He had NYHA Class IV symptoms and severe pre-tibial oedema,gross ascites,and bilateral pleural effusion.There was a history of NSTEMI 12 months earlier,without any complications.Trans- thoracic echocardiography and MRI demonstrated severe diastolic dysfunction,and increased pericardial thickness.

Result
Surgical pericardiectomy was performed via median sternotomy. The anterior pericardium was first removed,and rest of the operation is completed on beating heart under cardiopulmonary bypass,instituted by femoro-femoral cannulation. Complete pericardial resection was undertaken,except posterior to the left atrium,with special attention paid in order to preserve the phrenic nerves.Post-operative recovery was event free,except for extended pleural drainage.Pericardial biopsy demonstrated inflammation with a suspicion of a previous haemorrhage.Post-operative follow-up at 3 months confirmed complete clinical and cardiac recovery,as documented by echocardiography and MRI.

Conclusion
Complete investigation using non-invasive and invasive imaging help confirm the diagnosis of constrictive pericarditis and exclude restrictive cardiomyopathy.Once the diagnosis is confirmed,pericardiectomy, with complete decortication(if technically feasible) is the treatment of choice for constrictive pericarditis,and it provides good symptomatic relief.