Mr. Wu, 67 years old, found that he had edema in both legs and chest and abdominal discomfort since half a year ago, and went to a neighboring hospital for examination and found that in addition to lower limb edema, he also had liver bruising, peritoneal effusion and pleural effusion. After examination, he was diagnosed with constrictive pericarditis and was admitted to the thoracic surgery department. The constricted pericardium restricted the diastolic function of the heart, resulting in restricted blood return and decreased cardiac output, resulting in edema, liver stasis, pleural effusion, peritoneal effusion, hypoproteinemia and other manifestations. After 7 days, Mr. Wu’s vital indicators have been adjusted to a state suitable for surgery. Our department performed pericardial dissection for Mr. Wu, because of the patient’s cardiac insufficiency, the patient was awake under local anesthesia with awake state tracheal intubation, indwelling puncture tubes for monitoring the superior and inferior vena cava, invasive blood pressure, monitoring central venous pressure, etc. The sternum was split in the middle, with a clear view, easy to peel the thickened pericardium in the upper and lower vena cava and the right heart margin area, and the postoperative impact on respiratory function was small, we found intraoperative pericardial thickening up to 2cm According to the basic scope of stripping, the apical part of the heart should be completely stripped; the fibrous narrowing ring on the left side near the left phrenic nerve, the atrioventricular sulcus and the entrance of the inferior vena cava must be loosened. The sequence of stripping should be left ventricle → right ventricular outflow tract → atrioventricular sulcus narrowing ring → inferior vena cava circumflex bundle. When calcified plaques or tight adhesions are encountered that cannot be separated, the residual portion is left open and multiple cross-shaped incisions are made on its surface to loosen the myocardium. After complete release, the infusion rate was limited, and the pericardial dissection was successfully completed with perfect cooperation between the surgeon, anesthesiologist and nurse, and mediastinal lymph node biopsy was performed in parallel according to the CT results. The postoperative pathology suggested tuberculosis, and the diagnosis was tuberculous constrictive pericarditis with significant improvement of symptoms. Postoperative anti-tuberculosis treatment was given, and the care of airway and drainage was strengthened. According to the director of our department, the development of constrictive pericarditis is relatively rare. When the pericardium has inflammatory lesions, there are fibrin deposits on both the mural pleura and the dirty pleura, and after the fluid accumulation is gradually absorbed, it forms fibrous tissue along with granulation tissue fibrosis. The wall and dirty layer tissues adhere together, the pericardial cavity is occluded, the pericardium is thickened to varying degrees, sometimes up to 1 cm or more, and a narrowing ring can be formed at the entrance of the vena cava, resulting in serious obstruction of blood flow, and over time the condition even appears as pericardial calcification and myocardial atrophy. Typical signs and symptoms include: hepatic stasis and enlargement, hydrothorax and ascites, dyspnea, palpitations and shortness of breath after activity, facial and extremity edema, especially ankle edema, etc. It is often easily misdiagnosed as other diseases, and measurement of blood pressure shows a decrease in systolic pressure and a relative increase in diastolic pressure, with a decrease in the difference between the two. Half of the onset of this disease is caused by tuberculosis. In addition, viral or bacterial infections, connective tissue disease, chest trauma, parasites, uremia, and tumors are also causative factors of constrictive pericarditis. The incidence of the disease has been declining as people’s living conditions improve. Once the pericardial lesion forms irreversible fibrosis, the only treatment is pericardial exenteration, and medical treatment can only improve the patient’s general condition in preparation for surgery. Myocardial atrophy. This is the first case in our department in which a large pericardial surgery was performed in a non-extracorporeal cardiac non-stop manner, which is extremely risky and indicates the high level of development of cardiothoracic surgery in our hospital.