Pericardiectomy
Pericardiectomy | |
---|---|
ICD-9-CM | 37.31 |
MeSH | D010492 |
Pericardiectomy is the surgical removal of part or most of the pericardium.[1][2] This operation is most commonly used to relieve constrictive pericarditis, or to remove a pericardium that is calcified and fibrous.[2] It may also be used for severe or recurrent cases of pericardial effusion.[3] Post-operative outcomes and mortality are significantly impacted by the disease it is used to treat.[4][5]
Uses
Pericardiectomy is used to treat constrictive pericarditis, which is caused by a variety of conditions.[2][3] It is also used to treat recurring cases of pericardial effusion.[3][4]
Contra-indications
Pericardiectomy should not be used if more minor procedures are more appropriate, such as a pericardial 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 of complications and a higher mortality.[6] More conservative treatment may use diuretics, digoxin, steroids, NSAIDs, or antibiotics to change cardiovascular 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]
Risks
Pericardiectomy can cause a number of cardiac issues, such as arrhythmia, low cardiac output syndrome, and myocardial infarction (in rare cases).[2] There is some risk of damage to the pleural cavities around the lungs, which can lead to pneumonia, or pleural effusion.[2] It also presents typical surgical risks, such as infection, anaesthesia complications, blood clots, and bleeding.[2][3] There is a low risk of haemorrhage if the heart is perforated whilst removing the pericardium.[3]
Outcomes after surgery depend significantly on the underlying cause of illness, and the function of the kidneys, left ventricle, and pulmonary arteries.[5] Recovery from pericardial effusion treated with pericardiectomy is typically very good. However, its use for treating constrictive pericarditis has a fairly high mortality rate, initially between 5% and 15%.[3][4] The 5-year survival rate is around 80%.[3] The most common complication after surgery is reduced cardiac output, which occurs in between 14% and 28% of patients.[4]
Technique
Pericardiectomy takes place by removing the infected, fibrosed, or otherwise damaged pericardium. The procedure begins when the
Recovery
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 a chest drain to remove pericardial fluid.[2] Hospital recovery takes several days, with surgical suture removed after a week.[2]
After pericardiectomy, the heart takes on a more rounded shape due to the lack of stretch with the diaphragm.[9] This does not appear to cause any cardiac issues, but may be detected with echocardiography.[9]
See also
- List of surgeries by type
References
- ISBN 9781451113150. Archivedfrom the original on 2024-01-15. Retrieved 2020-09-26.
- ^ a b c d e f g h "Pericardiectomy". www.hopkinsmedicine.org. 19 November 2019. Archived from the original on 2020-11-30. Retrieved 2020-12-03.
- ^ ISBN 978-1-4160-3786-6, archivedfrom the original on 2021-02-10, retrieved 2020-12-03
- ^ ISBN 978-0-323-49798-5, archivedfrom the original on 2021-02-10, retrieved 2020-12-03
- ^ ISBN 978-0-7020-6929-1, retrieved 2020-12-03
- ^ ISBN 978-0-323-04841-5, archivedfrom the original on 2021-02-10, retrieved 2020-12-03
- ^ ISBN 978-0-323-04525-4, retrieved 2020-12-03
- ISBN 978-1-4377-1725-9, archivedfrom the original on 2021-02-10, retrieved 2020-12-03
- ^ ISBN 978-1-4557-0761-4, archivedfrom the original on 2021-02-10, retrieved 2020-12-03