DISCUSSION
CP may be caused by various factors, some of which may be transient,
while TBCP may manifest as a progressive constriction even treated.
Although idiopathic, post-cardiac surgery and radiation were the three
most common etiologies of CP in some developed countries. Considering
the high incidence of TBP in developing countries, the prevalence of
MDR-TB, the impact of HIV, T2DM, obesity and some national policies, TB
will still be the main cause of CP for a long time worldwide.
Constriction is the end-stage manifestation of TBP, which contributes to
the death of patients with TBP. Early Diagnosis and treatment of TBCP
are crucial for prognosis. As we have known that TBP has four
pathological stages-dry, effusive, absorptive, and constrictive.
However, many patients with TBCP who give no history of an acute attack
have in fact had such an attack, which has been overlooked because of
the mildness of the constitutional symptoms. For these patients, it is
still controversial whether the constriction results from the
progression of acute pericarditis from a dry stage sequentially through
an effusive, absorptive and constrictive
phase[71,72]. Moreover, when it progresses to
chronic constriction, the etiologic Diagnosis may be more impossible and
the treatment only left pericardiectomy. Limited by the fibrosis
pericardium for a long time, the myocardial function may be impaired.
The perioperative mortality rate is high even with extracorporeal
circulation while calcification has penetrated the myocardium causing a
reconstruction of the heart.
To date, little progress has made in our understanding of the
immunopathogenesis of TBCP, especially accompanied by HIV, T2DM, and
obesity. Neither a relatively inexpensive, rapid, accurate, and widely
available test has been developed, nor the determinants and drivers of
TBCP have been understood, much less is the pharmacokinetics and
pharmacodynamics of anti-tuberculous drugs in both plasma and the
pericardium and their impact on short- and long-term outcomes.
Therefore, there seems to be a long way to go[73].