| Pericardiectomy | |
|---|---|
| ICD-9-CM | 37.31 |
| MeSH | D010492 |
Pericardiectomy is the surgical removal of part or most of thepericardium.[1][2] This operation is most commonly used to relieveconstrictive pericarditis, or to remove a pericardium that iscalcified andfibrous.[2] It may also be used for severe or recurrent cases ofpericardial effusion.[3] Post-operative outcomes and mortality are significantly impacted by the disease it is used to treat.[4][5]
Pericardiectomy is used to treatconstrictive pericarditis, which is caused by a variety of conditions.[2][3] It is also used to treat recurring cases ofpericardial effusion.[3][4]
Pericardiectomy should not be used if more minor procedures are more appropriate, such as apericardial window.[6] Pericardiectomy may not be appropriate for patients who already have a poor prognosis, as its medical benefit is reduced. This is because pericardiectomy has a higher rate ofcomplications and a highermortality.[6] More conservative treatment may usediuretics,digoxin,steroids,NSAIDs, orantibiotics to changecardiovascular physiology without treating the underlying pathology, which is appropriate for those not suitable for major surgery.[7] Some patients may undergo conservative treatment for a number of months before pericardiectomy is considered truly necessary.[7]
Pericardiectomy can cause a number of cardiac issues, such asarrhythmia, low cardiac output syndrome, andmyocardial infarction (in rare cases).[2] There is some risk of damage to thepleural cavities around thelungs, which can lead topneumonia, orpleural effusion.[2] It also presents typicalsurgical risks, such asinfection,anaesthesia complications,blood clots, andbleeding.[2][3] There is a low risk ofhaemorrhage if the heart isperforated whilst removing the pericardium.[3]
Outcomes after surgery depend significantly on the underlying cause of illness, and the function of thekidneys,left ventricle, andpulmonary arteries.[5] Recovery from pericardial effusion treated with pericardiectomy is typically very good. However, its use for treating constrictive pericarditis has a fairly highmortality rate, initially between 5% and 15%.[3][4] The 5-year survival rate is around 80%.[3] The most common complication after surgery is reducedcardiac output, which occurs in between 14% and 28% of patients.[4]
Pericardiectomy takes place by removing the infected, fibrosed, or otherwise damaged pericardium. The procedure begins when thesurgeon makes an incision in the skin over thebreastbone and divides the breastbone to expose the pericardium, known as amedian sternotomy.[3][6] Alternatively, a larger incision known as athoracotomy may be used.[6] During the surgery, the surgeon will hold the pericardium, cut the top of this fibrous covering of theheart, drop it into the specimen bag, and re-cover the heart. The breastbone is then wired back together and the incision is closed, completing the procedure. When the portion of pericardium lying between the twophrenic nerves is excised, it is called total pericardiectomy. In cases where total pericardiectomy is not possible, subtotal pericardiectomy is performed or, in extreme cases, a cruciate incision on the pericardium is performed.[citation needed]
Heart function often recovers very quickly after pericardiectomy is performed,[8] although the surgery itself can cause reduced cardiac output in the short term.[4] After surgery, many patients will have achest drain to removepericardial fluid.[2] Hospital recovery takes several days, withsurgical suture removed after a week.[2]
After pericardiectomy, the heart takes on a more rounded shape due to the lack of stretch with thediaphragm.[9] This does not appear to cause any cardiac issues, but may be detected withechocardiography.[9]
