Tuberculous Pericarditis Surgery: Procedure and Outcomes

Tuberculous pericarditis is a serious condition that often requires surgical intervention when medication alone is insufficient. The primary goal of the surgery is to remove the thickened, calcified layers of the pericardium that restrict the heart's normal movement. These layers, often described as "armor-like," form around the heart due to chronic inflammation caused by tuberculosis. This abnormal buildup prevents the heart from expanding and contracting properly, leading to symptoms such as shortness of breath, chest tightness, and reduced cardiac output.

Understanding the Surgical Approach

The procedure, known as pericardiectomy, involves the careful removal of both the visceral and parietal layers of the pericardium. Surgeons typically perform a median sternotomy, which allows full access to the heart by opening the chest cavity. Once the heart is exposed, the surgeon meticulously separates the calcified and fibrous tissue from the heart muscle without damaging the underlying structures. This step is crucial to restore normal cardiac function and relieve the constriction caused by the diseased pericardium.

Complete vs. Partial Pericardiectomy

In cases where the calcification is extensive but not deeply adherent to the myocardium, a complete pericardiectomy may be performed. This means removing the entire pericardial sac surrounding the heart. However, if the fibrosis is particularly dense and closely attached to critical areas such as the atria or major blood vessels, a partial removal may be more appropriate. During a partial procedure, the surgeon focuses on removing the pericardium around the aorta, pulmonary artery, superior and inferior vena cava, and parts of the left and right ventricles to significantly reduce constriction and improve heart function.

Expected Outcomes and Recovery

When performed successfully, this surgery can dramatically improve a patient's quality of life by restoring normal heart rhythm and function. Patients often experience relief from symptoms such as fatigue and dyspnea within weeks following the operation. Long-term outcomes are generally favorable, especially when the procedure is carried out before irreversible damage occurs to the heart muscle. Postoperative care typically includes continued anti-tuberculosis therapy and close monitoring to ensure there are no complications such as bleeding, infection, or recurrence of pericardial constriction.