How to Prepare for Pericardiectomy surgery?

[lwptoc]

Pericardiectomy is a surgery that involves removing the inflamed pericardium (a double-walled membrane sac covering an outer surface of the heart). Pericarditis is manifested with chest discomfort and accumulation of fluid in the pericardial cavity.

What is Pericarditis?

Pericarditis is an acute or chronic inflammatory condition of the pericardium. It causes chest discomfort and the accumulation of fluid in the pericardial cavity which leads to pericardial tamponade.

Pericarditis can be:

• a manifestation of systemic diseases
• a sign of heart disease
• a symptom of infectious diseases
• a complication of the internal organs
• the result of an injury

Inflammation of the pericardium can be:

• infectious,
• infectious and allergic,
• non-infectious (aseptic, non-purulent).

Infectious lesions include pericarditis when:

• Viral infections ( influenza, measles, herpes, enterovirus, and other infections).
• microbial diseases (scarlet fever, tonsillitis, tuberculosis),
• fungal infections
• parasitic invasions.

Also, pericarditis can result from drug allergies or serum sickness. Aseptic inflammation is formed as a result of:

• systemic diseases affecting connective tissue, including the heart.
• Cardiovascular disease: heart attack, myocarditis (inflammation of the myocardium) or endocarditis – inflammation of the inner lining of the heart,
• toxic and metabolic disorders in the development of uremia, gout, as a result of radiation or chemotherapy.

The signs of pericarditis depend on the form and stage of the process.

Acute pericardial inflammation usually produces fibrin secretions, and as the process develops, inflammatory fluid accumulates.

• There are pains in the heart and pericardial rubbing noise. The pains are usually dull and pressing, radiating to both shoulders, left shoulder blade, or subclavian region.
• The pain intensifies with deep breathing and coughing; in the supine position and decreases with a sitting position, breathing is frequent and shallow.

In what condition pericardiectomy is done?

Medications help to combat recurrent chronic pericarditis, purulent pericarditis, and constrictive pericarditis. For severe symptoms of the disease, a doctor suggests pericardiectomy. In some cases, pericarditis can cause an effusion into the bursa. It is a buildup of fluid in the pericardium that prevents the heart from contracting normally. In this case, the patient may need a pericardiectomy. It helps remove excess fluid and prevent it from returning.  

Pericardiectomy is necessary for people with chronic and constrictive pericarditis. It is usually not an option for those who have had a single case of pericarditis that can be treatable with medication. In severe cases, surgical treatment is inevitable.

The surgery is not performed on patients with myocardial fibrosis. It is one of the primary causes of death during surgery. Therefore, it is necessary to undergo a thorough examination before the intervention. A doctor also avoids the surgical procedure for people with pericardial calcification, renal failure, oncology, severe disorders of the respiratory and nervous systems. Pericardiectomy is contraindicated in elderly patients (over 80 years old) and patients who have received radiation therapy.

Pericardiectomy types

• Subtotal pericardiectomy:- A surgery that removes the entire pericardium. It is used more often than partial pericardiectomy. After such an intervention, only a small part of the pericardium remains near the posterior wall of the heart. 
• Partial pericardiectomy:- Excision of a part of the pericardium to eliminate cardio-pericardial fusion. This operation is performed for mild to moderate pericarditis.
• Thoracoscopy:- A minimally invasive surgery that allows removing minor areas of the inflamed pericardium through small punctures.
• Alternative methods:- Pericardiectomy is necessary for people with chronic constrictive pericarditis. It is usually not an option for those who have had a single case of pericarditis that can be treatable with medication. In severe cases, surgical treatment is inevitable. In chronic constrictive pericarditis, the pericardium becomes stiff and thick. It is due to repeated scarring, which restricts the heart movement and can cause heart failure.

Preparing for Pericardiectomy surgery

8-12 hours before the operation, the patient should stop eating and drinking. It is necessary to adhere to a healthy diet a few weeks before the surgery. It helps to reduce the load on the heart. Also, before pericardiectomy, you cannot take any medications without a doctor’s consultation. Before pericardiectomy, the patient undergoes multiple examinations to identify possible contraindications and complications. These diagnostic procedures include:

• chest X-ray ECG or EKG to check your heartbeat
• blood tests to assess your general health
• an echocardiogram to view the anatomy of the heart and blood flow through the heart
• CT or MRI if your doctor needs more information about the heart
• Cardiac catheterization to measure the pressure inside the heart.

Pericardiectomy technique

A pericardiectomy is an operation performed under general anesthesia. If necessary, the patient may be connected to artificial ventilation. The surgeon makes an incision above the sternum or between the ribs to gain access to the heart. Then he removes all or part of the pericardium and closes the wound.

Several small incisions on the side of the chest may also be used to access the pericardium. This pericardiectomy technique is called thoracoscopy or VATS. It is performed without opening the chest using microsurgical instruments and small video cameras that transmit an image of the operated area to a monitor. In this case, all adhesions are separated by a laser. Drainage catheters are installed for several days to ensure normal drainage of fluid post-surgery and minimize the risks of bleeding in the anterior mediastinum.

The duration of the surgery depends on the severity of the disease and the method of performing a surgical procedure. Roughly, pericardiectomy lasts from 2 to 4 hours (longer in severe cases).

Complications after pericardiectomy

Pericardiectomy is a complicated surgical procedure, so the risks of complications, although rare, are possible. The main negative consequences of the surgery include:

• bleeding in the pleural cavity
• irregular heartbeat
• suppuration of the surgical wound;
• heart attack
• purulent mediastinitis
• stroke
• low cardiac output syndrome
• pneumonia

Risks may vary depending on the patient’s age, general health, and the reason for the procedure. The complications are influenced by the heart condition, the structure, and the volume of fluid in the heart bag.

Recovery from pericardiectomy

Post-surgery, the patient is placed in an intensive care unit. Then, in the absence of complications and stabilization of the condition, it is transferred to the usual one. During this period, the patient can be prescribed heart disease drugs and medications, pain relievers, and antibiotics. Typically, stitches or staples are removed 7-10 days after surgery. For a speedy recovery, it is necessary to avoid lifting weights and taking adequate rest. Also, adhere to a diet and all doctor’s recommendations regarding exercise and wound care. Full recovery of the body after pericardiectomy occurs after 3-5 months.

Pericardiectomy cost

The cost of an operation to remove the inflamed membranes of the heart depends on:-

• the severity of the disease
• the form of pericarditis (chronic, acute, purulent)
• the presence of concomitant diseases
• the technique of surgical intervention

Prevention of pericarditis

To prevent the development of inflammation, you need to:-

• Treat infectious diseases on time.
• Take antibiotics if a bacterial disease develops.
• Streptococcal infection requires prophylaxis with penicillins.
• Treat caries, tonsillitis, and flu in time.
• Do sports.
• Eat right.
• Minimize stressful situations.
• Prevent hypothermia of the body.
• Treat the underlying disease.

Takeaway

Pericardiectomy is a direct surgical approach to treat pericarditis. It successfully clears the heart bag from purulent masses, calcified areas, and fibrous adhesions. A month after surgery, the patient’s condition improves significantly. After 3-5 months, normal heart function fully restores.