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Pericardiectomy for Constrictive Pericarditis

The pericardium is a thin, fluid-filled sac that envelopes and protects the heart. Pericardial effusion is a disease characterised by excess fluid accumulation in the pericardial sac. This interferes with the normal functioning of the heart. Pericardial effusion may be treated with pericardiectomy or pericardial stripping, which is a surgical procedure that involves the removal of a part of or the whole pericardium.

The pericardium is not essential for the normal functioning of the heart. In cases of pericarditis, the pericardium has already lost its ability to lubricate the heart. Therefore, removing the pericardium will not cause any harm to the normal functioning of the heart as long as the lungs and diaphragm (dome-shaped muscle that helps in breathing) are intact.

Indications

Pericardiectomy is commonly performed in patients suffering from constrictive pericarditis. During constrictive pericarditis, the pericardium becomes stiff and calcified. This prevents the heart from functioning normally. Constrictive pericarditis may be caused due to viral or bacterial infections, tuberculosis, mesothelioma (cancer in the lining of the lungs or abdomen) or surgical complications. Pericardiectomy is also indicated for the treatment of recurrent pericarditis (re-occurrence of pericarditis).

Procedure

During pericardiectomy, your doctor will make an incision through the breast bone (present on the middle front part of your ribs) to expose the heart. Your surgeon carefully removes the pericardium. The breast bone and ribs are fixed back firmly to their normal position and the incisions are sutured.

Post-operative care

Pericardiectomy is considered a major cardiac surgery. You may have to stay in the hospital for 5-7 days after surgery. You may be advised not to lift heavy weights. You may require 6-8 weeks to recover completely. As a part of follow-up treatment, your cardiologist may recommend an echocardiogram to evaluate the functioning of your heart. You may be prescribed lower doses of diuretics after surgery.

Risks and complications

As with all surgical procedures, pericardiectomy may be associated with certain complications, which may include bleeding, requirement of cardiopulmonary bypass (blood is bypassed around a blocked vessel) during the procedure, blood transfusion and sometimes even death. Women, elderly patients, and those suffering from other medical problems such as diabetes are at a greater risk for complications.

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