Pericardiectomy
 
 

Pericardiectomy

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Pericardiectomy

Pericardiectomy is a surgery to remove part or all of the sac around the heart. This lets the heart move more freely.

Why pericardiectomy is done

A fibrous sac surrounds the heart. The sac is called the pericardium. It’s made of 2 thin layers with a small amount of fluid between them. Normally, this sac is thin and flexible. But repeated inflammation can cause it to become stiff and thick. This is called chronic constrictive pericarditis. When this happens, the heart can’t move normally and fill up with as much blood as it should. This can cause increased pressure in the heart, and symptoms such as fatigue and swelling in the body. Cutting the sac away allows the heart to fill normally again. It does not fix the problem that caused the inflammation.

Risks of pericardiectomy

All surgery has some risks. The risks of pericardiectomy include:

  • Not enough oxygen getting out to the body (low cardiac output syndrome)

  • Excess bleeding

  • Infection

  • Fluid buildup around the lungs

  • Blood clot, which can lead to stroke or other problems

  • Abnormal heart rhythms (arrhythmias) that  can cause death in rare cases

  • Heart attack

  • Complications from anesthesia

Your own risks may vary according to your age, your general health, and the reason for your procedure. They may also vary depending on the structure of your heart and pericardium. Talk with your health care provider about which risks apply most to you.

Getting ready for your surgery

Talk with your health care provider how to get ready for your surgery. Tell him or her about all the medicines you take. This includes over-the-counter medicines such as ibuprofen. It also includes vitamins, herbs, and other supplements. You may need to stop taking some medicines before the surgery, such as blood thinners and aspirin.

Before your surgery, you may need tests such as:

  • Chest X-ray

  • Electrocardiogram (ECG), to check the heart rhythm

  • Blood tests, to look at your general health

  • Echocardiogram, to view your heart’s anatomy and blood flow through the heart

  • CT or MRI, if the doctor needs more information about your heart

  • Heart catheterization, to better examine the coronary blood vessels

Tell your health care provider if you:

  • Have had any recent changes in your health, such as an infection or fever

  • Are sensitive or allergic to any medicines, latex, tape, or anesthetic drugs (local and general)

  • Are pregnant or think you may be pregnant

Also, make sure to:

  • Ask a family member or friend to take you home from the hospital. You cannot drive yourself.

  • Not eat or drink after midnight the night before your surgery, unless your doctor says it’s OK.

  • Follow all other instructions from your health care provider.

You will be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully. Ask questions if something is not clear.

On the day of surgery

Your procedure will be done by a cardiologist. This is a doctor who specializes in diseases of the heart. He or she will work with a team of specialized nurses. The surgery can be done in more than one way. Ask your doctor about the details of your surgery. The surgery will take several hours. In general, you can expect the following:

  • You will have general anesthesia, medicine that allows you to sleep through the surgery. You won’t feel any pain during the surgery.

  • Hair in the area of the surgery may be removed.

  • A health care provider will watch your vital signs, like your heart rate and blood pressure, during the surgery.

  • Different types of procedures may be done. The surgeon may make a vertical incision along the breastbone. This incision will be several inches long. To reach the heart, the surgeon will separate the breastbone.

  • Or the surgeon may make an incision between the ribs to reach the pericardium.

  • Or the surgeon will make several smaller incisions on the side of the chest. A small camera and tools are inserted through these small incisions to do the surgery.

  • Some or all of the pericardium will be removed.

  • Other repairs may be done to the heart if needed.

  • All incisions will be closed. Dressings will be put on the incisions.

After your surgery

After surgery, you will be taken to a recovery room. Nurses will check your breathing, heart rate, and blood pressure. You may have a tube draining fluid from your chest. The drained fluid may be sent to a lab for analysis. You may stay in the hospital for a few days.

You may have some pain at the incision sites after surgery. You can take pain medicines to help relieve it. Only take pain medicine approved by your health care provider.

You might have some fluid leaking from your incision. This is normal. Let your doctor know right away if you see an increase in redness, swelling, or fluid from your incision.

Your original heart symptoms may go away quickly after your surgery.

You can go back to your normal food as soon as you feel able. When you go home, you should be able to resume normal activities. Avoid vigorous exercise until your doctor says you are ready. Don’t lift anything heavy until your doctor says it’s OK.

Follow-up care

You will probably have your stitches or staples removed in 7 to 10 days. Make sure you keep all of your follow-up appointments. Follow all the instructions your health care provider gives you for medicines, exercise, diet, and wound care.

 

When to call your health care provider

Call your health care provider right away if you have any of these:

  • Fever of 100.4°F (38°C) or higher

  • Increase in pain, redness, bleeding, or fluid leaking from the incision

  • Chest pain

  • Other symptoms as advised