Pericardectomy
Pericardectomy is the surgical removal of all part or most of the pericardium which is most commonly used to relieve constrictive pericarditis, or to remove a pericardium that is calcified and fibrous.
Some facts about Pericardectomy:
- Your heart is protected by a normal pericardium.
- But a stiff pericardium can lead to heart failure symptoms as it can't stretch enough.
- The pericardium is a double walled membrane sac that surrounds your heart and contains a small amount of fluid that lubricates your heart during its normal pumping movements within the pericardium and prevents friction between the two.
- Removing the pericardium doesn't cause problems as long as your lungs and diaphragm are intact as the pericardium isn't essential for normal heart function.
- Your pericardium already has lost its lubricating ability if you have pericarditis.
- Constrictive pericarditis is the most common reason for performing a pericardiectomy which is a condition in which your pericardium becomes stiff and possibly calcified.
- Your heart is prevented from stretching as it normally does when it beats because of this stiffness.
- Therefore, your heart chambers fill incompletely with blood, blood backs up from your heart into your lungs, your heart can't pump normally, your legs and abdomen may swell, and there may be symptoms of heart failure.
- Autoimmune disease, Cancer, that has spread from elsewhere in the body or cancer in the heart tissue itself; Infection of the heart or pericardial sac; Inflammation of the pericardial sac due to a heart attack; Radiation therapy to the chest; Reactions to certain medicines; Metabolic causes, like an underactive thyroid are some of the conditions that can cause constrictive pericarditis.
Preparation for Pericardectomy:
- It will be made sure that equipment is ready for a safe operation by your healthcare team.
- A cardiopulmonary bypass (the heart/lung machine) will be used by the surgeon which allows them to safely remove the pericardium from the sides and back of your heart.
Procedure for Pericardectomy:
- Surgical treatment is the best option for the most advanced cases of constrictive pericarditis.
- Pericardiectomy is usually open heart surgery that allows your surgeon to get to your heart to remove your entire pericardium.
- Open heart surgery is proffered to a partial pericardiectomy technique.
- Pericardiectomy is generally done under general anesthesia.
- An incision will be made through your breastbone (sternum) in the middle front part of your ribs by the surgeon that allows him/her to reach your heart.
- This incision is called a median sternotomy.
- The pericardium will be removed from your heart and your breastbone and ribs will be wired back together.
- Either a large part or the entire pericardium will be removed during this procedure.
- The incision will be closed with stitches.
- A thoracotomy approach, may be used by some surgeons in which they make a cut between your ribs to get to your heart.
- A minimally invasive approach is used by very few because it limits how much of the pericardium your surgeon can reach.
- Several small incisions on the side of the chest may be used which is called video-assisted thoracoscopy or VATS.
- Small cameras and tools are often used to do the surgery through these small holes.
- A pericardiectomy usually takes about two to three hours.
