Background: The presence of constrictive pericarditis (CP) in conjunction with tricuspid regurgitation (TR) and the worsening of TR following pericardiectomy are associated with a reduction in patient survival. The purpose of this study was to investigate the prevalence of tuberculous CP in conjunction with TR, the incidence of worsening regurgitation following pericardiectomy, and the analysis of associated factors.

Methods: Seventy-five consecutive patients who underwent pericardiectomy for tuberculous CP at the institution between January 2021 and December 2023 were retrospectively analyzed. Their clinical, imaging, and hemodynamic characteristics were analyzed.

Results: Among the 75 patients with tuberculous CP, 29 patients (38.7%) had mild or greater TR preoperatively and 27 patients (36%) had worsening TR after pericardiectomy. In patients with worsening TR, the pericardial thickness of the right ventricular (RV) lateral wall was significantly thickened preoperatively, and there was a reduction in the tricuspid annular plane systolic excursion (TAPSE), right ventricle S’ tissue Doppler velocity (S’), and right ventricle fractional area change (FAC) postoperatively. The preoperative inferior vena cava diameter and the postoperative right atrial and RV basal diameters were significantly larger in patients with worsening TR compared with patients with non-worsening TR, whereas the TAPSE, S’, and FAC were significantly lower before and after the surgery (P < .05). The FAC [OR = 0.354; 95% CI (0.165-0.761), P = .008] and pericardial thickness of the RV lateral wall [OR = 1.887; 95% CI (1.206-2.953), P = .005] were independently associated with worsening TR.

Conclusion: Patients with tuberculous CP often have coexisting TR, and pericardiectomy can lead to worsening TR. The pericardial thickness of the RV lateral wall and FAC are independently associated with worsening TR following pericardiectomy.