Removing the pericardium

, medical expert
Last reviewed: 07.07.2024

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The procedure of removing the pericardium is also called pericardectomy. It is a rather complex procedure that is performed mainly in cases of pericarditis of various origins. The procedure is also indicated in the development of severe bleeding, persistent and prolonged circulatory failure, especially if it affects the coronary vessels that supply blood to the heart. In purulent and septic processes, acute necrosis is also advisable to carry out this procedure. The formation of fibrous adhesions is also treated with pericardectomy (perhaps this is the only effective method of treatment in this case). Most often this procedure is used for syndromes and symptoms that are accompanied by compression of blood vessels, nerve damage.

The essence of the procedure is that the pericardium is removed completely, or a separate part of it. In this case, it is advisable to preserve only those areas of tissue in which the diaphragmatic nerves pass. Often it is the diaphragmatic nerves that determine the boundaries of pericardial removal.

There is a distinction between partial pericardectomy, in which only part of the pericardium is removed. This procedure is also called pericardiolysis or cardiolysis. In this case, the cardiac-pericardial fusion is subject to dissection. Removal of the pericardium is carried out near individual pericardial areas. Also distinguish a complete pericardectomy, in the process of which the entire pericardium is excised completely. This is a subtotal procedure, which is used more often than partial excision. In this case, only a small area of pericardium located on the posterior surface of the heart may be preserved. Complete excision of the pericardium is used mainly in cases of constrictive or exudative pericarditis, as well as in the presence of pronounced scarring changes in the cardiac tissue, with calcification or thickening of the pericardium. The degree of surgical intervention depends primarily on the severity and severity of the pathologic process.

It should be taken into account that this procedure is extremely risky and carries a huge risk of lethal outcome right on the operating table. This procedure is especially dangerous (and therefore strictly contraindicated) for patients suffering from severe pericardial calcification, myocardial fibrosis, and various degrees of pericardial constriction. It should also be taken into account that the risk of lethal outcome depends largely on the patient's kidney condition, age, concomitant diseases. The risk of lethal outcome increases if the patient has undergone radiation therapy, exposure to radioactive radiation.

The operation requires serious preliminary preparation. So, first of all, it is necessary to take into account that before prescribing surgery, it is necessary to take measures aimed at reducing the severity of heart failure, congestion in the heart area. In this case, the patient is prescribed a special diet, as well as cardiovascular and diuretics.

The operation is performed by a cardiac surgeon. There are quite a few different techniques for performing the procedure. Intrapleural or extrapleural access is used. Both one and two cavities can be opened. The operation is performed under general anesthesia. If necessary, an artificial respiration apparatus is connected. During the entire procedure, it is necessary to carry out strict control of the heart, blood flow. Respiratory function is also controlled, constant monitoring of blood pressure is carried out.

Endotracheal anesthesia is used for the purpose of anesthesia. Sternal dissection is unavoidable during the operation. First, a small incision is made in the left pericardium. We gain access to the left ventricle. After that, an incision is made over the left ventricle, which exposes the epicardium. The surgeon then finds the layer that separates the pericardium and epicardium. The edges of the pericardium are grasped with surgical instruments, after which the surgeon begins to gently pull them apart. At the same time, the separation of the pericardium from the epicardium is performed.

If calcified areas are found that penetrate deep into the pericardium, they are bypassed around the perimeter and left. Care should be taken when dissecting the pericardium if the dissection site is located near the coronary vessels. It is also necessary to be especially careful when releasing atria and hollow veins, as they have extremely thin walls. The pericardium should be peeled off starting from the left ventricle. Then go to the atrium, then - on the aorta, pulmonary trunk. Then go to the right side (ventricle, atrium, hollow veins are released). Observance of such a sequence allows you to prevent the risk of developing pulmonary edema. After that, the pericardium is dissected, its edges are sutured to the intercostal muscles. The wound surface is sutured layer by layer. To drain the fluid it is necessary to install a drain (for 2-3 days). The average duration of the operation is 2-4 hours. In some cases, video technology, laser (for access) is used.

Compliance with the postoperative period is required. Thus, immediately after the procedure, the patient is placed in the postoperative unit, after which he is transferred to the intensive care unit. The average duration of hospitalization is 5-7 days. Depends on the speed of recovery processes.

Complications may occur. Early postoperative complications include bleeding into the pleural cavity, increased heart failure. Later, such complications as pus formation, development of purulent-septic process may occur. Purulent mediastinitis develops. After surgery, the patient is prescribed antibiotics, painkillers, cardiac drugs. Protein preparations are administered, in particular, plasma.

In most cases, the further prognosis is favorable. Already in a month the patient feels much better, in 3-4 months there is a complete recovery of the functional state of the heart. The pericardium heals. Lethality is 5-7%. The main cause of mortality is the development of fibrosis. It is obligatory to attend scheduled examinations of a cardiologist. As a rule, there is a complete restoration of the ability to work.

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