To explore the clinical effects, complications, mortality, and prognosis associated with different treatment schemes for tuberculous pericarditis with rapid progression to constrictive pericarditis (rapidly progressive tuberculous pericarditis), in order to obtain better therapeutic effects for the treatment of tuberculous pericarditis.

From June 2014 to May 2019, 38 cases of rapidly progressive tuberculous pericarditis were treated by different treatments. The timing, method and effect of surgical intervention, complications, mortality, and follow-up data were analyzed retrospectively. Treatment methods included drug therapy, pericardiocentesis and drainage, pericardiotomy, and pericardiectomy. Meanwhile, 115 cases of chronic constrictive pericarditis treated surgically were also observed.

Different treatment schemes were used for the treatment of rapidly progressive tuberculous pericarditis, with a follow-up of 1-5 years. All patients were treated with antituberculosis drugs. Among all cases involved, 5 were treated with drugs alone and all of them developed into constrictive pericarditis; 12 were treated by pericardiocentesis and drainage in early stage, of which 1 was cured, and the other 11 developed into chronic constrictive pericarditis; 10 were treated by pericardiotomy in early stage, of which 1 developed into chronic constrictive pericarditis and 9 were cured; 11 underwent early pericardiectomy and there was no progression to chronic constrictive pericarditis. No perioperative deaths occurred. Compared with the patients with chronic constrictive pericarditis who underwent surgical treatment in the same period, the incidence of low cardiac output syndrome was lower in patients with rapidly progressive tuberculous pericarditis who underwent surgical treatment (4.8% vs 24.3%, P＜0.05), the improvement of cardiac function was better (100.0% vs 80.7%, P＜0.05), and the 5-year follow-up survival rate was higher (100% vs 78%, P＜0.05).

A high proportion of cases of rapidly progressive tuberculous pericarditis treated only with drugs or by pericardiocentesis will progress to constrictive pericarditis, which will seriously affect the prognosis of patients. Early surgical intervention can significantly reduce the rate of rapidly progression of tuberculous pericarditis to constrictive pericarditis, thus improving the overall prognosis of patients and their quality of life and reducing the social burden.