Constrictive Pericarditis Surgical Treatment Options

Understanding Constrictive Pericarditis Surgery

Constrictive pericarditis surgery, commonly referred to as pericardiectomy or pericardial window procedure, is performed under general anesthesia and typically does not require the use of cardiopulmonary bypass or cardiac arrest. The preferred surgical approach is through a median sternotomy, where the sternum is divided to access the pericardial space. Surgeons carefully remove the thickened, fibrotic, and calcified pericardium that restricts the heart's normal contraction and relaxation, thereby restoring cardiac function.

Key Surgical Techniques and Considerations

Targeted Pericardial Removal

While it may not always be feasible to remove all the thickened tissue in certain patients, special attention is given to critical anatomical areas. This includes the regions around major veins such as the superior and inferior vena cava, where constriction significantly impacts venous return to the heart. Releasing the pressure in these areas is crucial for achieving successful surgical outcomes.

Relief of Cardiac Compression

Other vital areas, such as the bases of the great vessels and regions where atrial and ventricular expansion is severely restricted, must also be addressed. By alleviating the compression in these zones, normal venous blood flow can be restored, improving overall hemodynamics and cardiac efficiency.

Postoperative Care and Long-Term Monitoring

After the surgery, a drainage tube is typically left in the pericardial cavity to ensure proper fluid evacuation. Once the drainage subsides, patients undergo long-term follow-up to monitor for potential recurrence of pericardial thickening, fibrosis, or calcification. Regular check-ups are essential to maintain cardiac health and prevent future complications.