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Surgical Pericardiectomy

Surgical removal of the pericardium for constrictive pericarditis or refractory effusion.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Surgical Pericardiectomy?

Pericardiectomy is surgical removal of the pericardium, the fibroserous sac surrounding the heart. The procedure is performed for constrictive pericarditis (most common indication), recurrent effusive-constrictive disease, recurrent cardiac tamponade and chronic relapsing pericarditis refractory to medical therapy. Etiologies include idiopathic, post-cardiac surgery, post-radiation, tuberculous, autoimmune and uremic pericarditis.

Surgical approaches include median sternotomy (with or without cardiopulmonary bypass) and left anterolateral thoracotomy. Total pericardiectomy involves resection of pericardium between phrenic nerves, freeing the right and left ventricles, atria and great vessels. Operative mortality is 5-15% with higher rates in radiation pericarditis. Functional improvement may take weeks to months as the heart adapts to unrestricted filling.

Symptoms

Constrictive pericarditis with heart failure symptoms
Recurrent effusive-constrictive pericarditis
Refractory pericardial effusion despite drainage
Cardiac tamponade with recurrent recurrence
Chronic recurrent pericarditis with refractory symptoms
Pericardial constriction post-cardiac surgery
Tuberculous constrictive pericarditis
Radiation-induced constrictive pericarditis

Risk Factors

Prior cardiac surgery
Radiation therapy to mediastinum (breast cancer, lymphoma)
Tuberculous infection (especially in endemic areas)
Autoimmune diseases (SLE, rheumatoid arthritis)
End-stage renal disease and uremia
Idiopathic recurrent pericarditis
Severe cardiac dysfunction (high mortality)
Advanced age and frailty

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Heart failure symptoms with normal ventricular function
  • Persistent ascites and lower extremity edema
  • Pericardial knock on cardiac auscultation
  • Recurrent pericardial effusion despite treatment
  • Tamponade requiring repeated drainage
  • Chest pain refractory to anti-inflammatory therapy

Treatment Methods

01
Comprehensive cardiac evaluation (echocardiography, MRI, catheterization)
02
Hemodynamic study to confirm constriction
03
Median sternotomy or thoracotomy approach
04
Cardiopulmonary bypass available if needed
05
Total pericardiectomy between phrenic nerves
06
Decortication of visceral pericardium
07
Postoperative ICU monitoring with hemodynamic support
08
Diuresis to manage volume status
09
Inotropic support if low cardiac output
10
Anti-inflammatory therapy if recurrent inflammation
11
Cardiac rehabilitation and long-term follow-up

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.