Constrictive Pericarditis Surgical Procedure: A Step-by-Step Guide

Constrictive pericarditis is a chronic condition in which the pericardium becomes thickened and rigid, restricting the heart's normal function. Surgical intervention is often necessary to relieve symptoms and restore cardiac performance. Below is a comprehensive overview of the surgical process, from preparation to long-term recovery.

Preoperative Preparation

Prior to surgery, patients often experience a range of systemic symptoms including fluid retention, low protein levels, liver dysfunction, and generalized edema. These conditions must be carefully managed to reduce surgical risk. Medical interventions such as diuretic therapy and nutritional support are commonly used to stabilize the patient's health and optimize readiness for the operating room.

Anesthesia and Incision

Once the patient is deemed stable, general anesthesia is administered. Unlike some cardiac procedures, extracorporeal circulation is typically not required for pericardial stripping. The surgeon then makes an incision through the left anterior chest wall, accessing the pericardial space through the intercostal space.

Pericardial Resection

Removal of Affected Tissue

The core of the procedure involves the meticulous removal of the thickened and adherent pericardium. The goal is to free the heart from constriction while preserving vital structures. Surgeons aim to excise as much abnormal tissue as safely possible to prevent recurrence.

Drainage Placement

Following the removal, a drainage tube is placed within the pericardial space to prevent fluid accumulation and reduce the risk of postoperative complications such as tamponade.

Postoperative Recovery

In the days following surgery, the drainage output is closely monitored. Once the volume decreases to an acceptable level, the drain is typically removed. Patients are encouraged to gradually resume normal activities under medical supervision to promote healing and functional recovery.

Long-Term Monitoring and Follow-Up

Successful surgical outcomes depend on consistent follow-up care. Patients should undergo regular echocardiographic evaluations to monitor for signs of recurrence, such as pericardial thickening, fibrosis, or fluid buildup. Early detection allows for timely intervention and improved long-term prognosis.